A Comparative Overview of Laparoscopic and Conventional Open Appendicectomy

This chapter outlines the outcomes of laparoscopic appendicectomy compared to open conventional appendicectomy in a tertiary care set up with aim to validate advantages and shortcomings of both procedures. Appendectomy for acute appendicitis is one of the most frequent indications for emergent abdominal surgery. An important anatomical landmark for surgeons performing appendectomy is the convergence of the taeniae coli which marks the base of the appendix. By following them inferiorly, the appendix can be located and resected.

A prospective analytical observational study was carried out in the department of Surgery Sri Aurvindo Institute of Medical Sciences and Research Centre, Indore, Madhya Pradesh India from July 2014 to August 2015. A series of 80 cases above 18 years of age with clinical diagnosis of appendicitis having Alvarado score of seven and above were studied prospectively under the two groups after proper written consent: Open appendectomy-40 cases, Laparoscopic appendectomy-40 cases. Intraoperative complications, extra diagnostic potential, operating time, postoperative analgesia, postoperative problems, length of hospital stay, subjective cosmesis, and return to regular, everyday activities were all factors that were compared between the two groups. Statistics were used to analyse the values.

The median operative time in Laparoscopic Appendicectomy was 58.22 minutes (range 32.68-85.46 min) as compared to open procedure which took 43.65 minutes (30.36-65.48min) (P<0.05). Conversion to open procedure was done in 10% (n=4) of laparoscopic cases. Mean value of postoperative pain by visual analogue scale was low in Laparoscopic Appendicectomy (LA) compared to Open Appendicectomy (OA) (P<0.05). Mean post-operative stay (3.2±0.34 days versus 2.3±0.24 days) and surgical site infection was recorded in 10 patients (25%) in OA group and 5 (13.9%) in LA group (P<0.05).

It is concluded that laparoscopic appendectomy is a safe and effective method for treating acute appendicitis. It has the advantages of improved intra-abdominal visualisation for additional pathologies, lower post-operative morbidity, and better cosmesis, but at the cost of high setup and maintenance costs that must ultimately be covered by the patient or the institution.