Laparoscopic versus open appendectomy; which method to choose? A prospective randomized comparison

Appendicitis is the most common surgical emergency with the incidence rate of 6-10%. Although several studies have compared the two approaches of open (OA) and laparoscopic appendectomy (LA) the technique of choice is still a matter of controversy. Considering this background we designed a study to compare OA and LA outcomes in our center. One hundred patients were included in this study performed from April 2008 to April 2009 at Shahid Sadoughi hospital, Yazd, Iran. Patients who gave informed consent were randomized to either OA or LA groups and were operated by McBurney's or laparoscopic technique, respectively. Patients received our center's routine diet, antibiotics and analgesic regimens. The patients' pain was measured by visual analogue scale (VAS) at their entrance to the recovery room and in 6-hour intervals up to 24 hours. Post-operation follow up visits were in weeks 1, 2 and 4. The data of operation time, hospital stay, intra-operation complications, time to resume normal activity, short term complications and neuralgia were collected and analysed. The average operation time was 34.4±8.42 min in LA and 41.7±8.84 in OA hand (P=0001). No intra-operative complication and no LA to OA conversion were encountered in operations. Post-operative complication rate was higher in OA group (n=10) compared to LA (n=3). The post-operative pain showed less pain in OA only at 6 and 12 hours post-operative times. Patients' mean hospital stay was 52.32±19.2 and 42.96±13.8 hours in LA and OA groups, respectively (P=0.003). Time to resume normal activity didn't show a significant difference between two groups (P=0.53). Only one case of neuralgia in the OA group was confronted in the follow up visits. LA has less complications and cosmetic scar with the cost of more pain. Decision between OA and LA for each patient should be made individually.