Laparoscopic versus open appendectomy in West Bengal, India

Laparoscopic appendectomy, although widely practiced, has not gained universal approval. Laparoscopic appendectomy in India is relatively new, and reports regarding its use are few. The aim of this study was to compare laparoscopic with open appendectomy and ascertain its therapeutic benefit, if any, in the overall management of acute appendicitis.

The study group consisted of 279 patients suffering from acute appendicitis. One hundred patients underwent laparoscopic appendectomy (LA) and 179 patients underwent open appendectomy (OA). Comparisons were based on median values for length of hospital stay, operating time, postoperative morbidity, duration of convalescence and operative cost. Mann-Whitney statistics (T) were calculated and, because of the large sample size, the normal deviate test (Z) was used.

Of the 100 patients who were to receive LA, six patients (6%) had the procedure converted to open surgery. The rate of overall complications (LA 15%vs OA 31.8%; P < 0.001) was significantly lower in patients undergoing LA. The median length of stay was significantly shorter after LA (3 days after LA vs 5 days after OA; P < 0.0001) than after OA. The operating time was shorter (median values: OA 25 min vs LA 28 min; 0.01 < P < 0.05) in patients undergoing OA compared with LA.

For LA, hospital stay was significantly shorter, and the one-time operative cost appeared to be marginally the same as open surgery. Furthermore, LA was associated with increased clinical comfort in terms of fewer wound infections, faster recovery, earlier return to work and improved cosmesis.