Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety

Area of Science:

• Surgical innovation and patient outcomes.
• Comparative effectiveness research in general surgery.

Background:

• Limited randomized controlled trials (RCTs) exist comparing open appendectomy (OA) and laparoscopic appendectomy (LA) for complicated appendicitis.
• Previous meta-analyses suggest LA benefits, but with weak evidence (Level 3a).

Purpose of the Study:

• To evaluate the safety and efficacy of laparoscopic appendectomy (LA) versus open appendectomy (OA) in patients with complicated appendicitis.
• To compare primary outcomes of all-cause and procedure-related mortality.
• To assess secondary outcomes including operative duration, wound sepsis, re-intervention, hospital stay, and re-admission rates.

Main Methods:

• Prospective randomized controlled trial involving 114 patients.
• Patients randomized to either OA or LA using a computer-generated blind method.
• Exclusion criteria included age <12 years, prior abdominal surgery, and pregnancy. Procedures performed by experienced surgeons.

Main Results:

• No statistically significant differences were observed between OA and LA groups in operative duration, wound sepsis rates, re-operation numbers, hospital stay length, or re-admission rates.
• Key safety outcomes (mortality, complications) were comparable between the two surgical approaches.

Conclusions:

• Laparoscopic appendectomy (LA) is a safe and effective treatment option for complicated appendicitis.
• The findings support the use of LA in this patient population, challenging previous assumptions about its risks compared to OA.