Abstract
INTRODUCTION: Laparoscopic appendectomy is now widely regarded as the preferred approach for acute appendicitis. However, its role in complicated appendicitis remains debated, particularly in settings where open surgery is still frequently performed. This study aimed to compare outcomes of laparoscopic and open appendectomy in both complicated and uncomplicated appendicitis. METHODS: We conducted a retrospective, single-center cohort study of adult patients (≥18 years) who underwent appendectomy between January 1, 2023, and December 31, 2024, at the Department of General Surgery, Health One Super Speciality Hospital, Ahmedabad, India. Patients undergoing concomitant major abdominal procedures, interval appendectomy, or with incomplete records were excluded. Outcomes assessed included operative time, postoperative complications, reoperation, and length of hospital stay. RESULTS: Of 337 patients, 282 were included in the final analysis (248 laparoscopic, 34 open). Median operative time was longer in laparoscopic surgery (60 vs 50 minutes; p=0.020). Drains were placed only in two complicated open cases. Overall, postoperative ileus was more frequent in the open group (14.7% vs 4.0%; p=0.020). Surgical site infections (SSIs) were more common after open appendectomy, though differences were not statistically significant. Median hospital stay was significantly shorter for laparoscopic cases (four vs six days; p<0.001). In complicated appendicitis, laparoscopic appendectomy was associated with a lower ileus rate (7.1% vs 26.3%; p=0.025) and shorter stay (five vs seven days; p<0.001). In uncomplicated appendicitis, complication rates were low in both groups, but laparoscopic surgery reduced hospital stay (three vs five days; p<0.001). CONCLUSION: Laparoscopic appendectomy demonstrated favorable outcomes compared with open surgery, particularly in complicated appendicitis, with reduced ileus and shorter hospitalization. These findings support laparoscopic surgery as the preferred approach for both complicated and uncomplicated appendicitis in adult patients.