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General SurgeryMS Surgery

Comparative Analysis of Outcomes in Laparoscopic versus Open Appendectomy for Complicated Appendicitis: A Prospective Cohort Study

Dr. Arjun Mehta¹, Dr. Sunita Patel¹, Dr. K. Venkatesh²

¹ Dept. of General Surgery, Grant Medical College, Mumbai · ² Dept. of Anaesthesiology

P2

ASI Annual Conference 2025 — Association of Surgeons of India

Background
  • Complicated appendicitis (gangrenous/perforated) carries 10× higher morbidity than simple appendicitis
  • Laparoscopic appendectomy (LA) has established benefits in simple cases but evidence for complicated cases remains conflicting
  • Indian data on LA vs Open Appendectomy (OA) outcomes in complicated appendicitis is limited to retrospective series
Objective

To compare 30-day postoperative outcomes — wound infection, hospital stay, return to activity, and conversion rate — between laparoscopic and open appendectomy in complicated appendicitis.

Methods
Design:Prospective cohort study
Setting:Surgical wards, Grant Medical College & Sir J.J. Hospital, Mumbai
Period:March 2024 – February 2025
Sample:n = 104 (52 LA, 52 OA) — power calculation based on wound infection rate (α = 0.05, power = 80%)
Statistics:Chi-square, Independent t-test, Kaplan-Meier survival (SPSS v27, significance p < 0.05)
Key Findings
Wound SSI Ratep = 0.018

LA 7.7% vs OA 25%

RR = 0.31 (95% CI 0.11–0.84)

Hospital Stayp < 0.001

LA 3.2d vs OA 5.8d

Difference: 2.6 days

Return to Workp < 0.001

LA 12d vs OA 21d

9 days earlier

Conversion RateN/A

5.8% (3/52)

Gangrenous appendix — predicted

Results

Laparoscopic appendectomy significantly reduced wound SSI (7.7% vs 25%, p = 0.018), mean hospital stay (3.2 vs 5.8 days, p < 0.001), and time to return to normal activity (12 vs 21 days, p < 0.001). Intraoperative time was longer for LA (68 vs 52 min, p = 0.003) but overall outcomes favoured LA.

Conclusion

Laparoscopic appendectomy is safe and superior to open surgery for complicated appendicitis in terms of wound infection, recovery, and hospital stay. LA should be the preferred approach even in gangrenous/perforated appendicitis at centres with laparoscopic expertise.

Take-Home Message

Laparoscopy for complicated appendicitis cuts wound infections by 70% and sends patients home 2.6 days sooner.

References
  1. 1. Jaschinski T et al. Laparoscopic vs open surgery for suspected appendicitis. Cochrane Database. 2018
  2. 2. Pandya SA et al. Laparoscopic appendectomy in complicated appendicitis — Indian experience. Indian J Surg. 2024;86(1):44

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Poster 2 of 5 · General Surgery