Comparison of surgical outcomes of laparoscopic and open appendectomy for perforated Appendicitis: A clinical experimental study assessing surgical site infections, operative time hospital stay and postoperative recovery.

Abstract

Objective: To compare the frequency of SSIs, operative time, length of hospital stay, and time to return to routine activities between LA and OA in patients with perforated appendicitis. Study Design: Randomized Control Trial. Setting: Department of General Surgery, Allied Hospital, Faisalabad. Period: October 31, 2021, to April 30, 2022. Methods: A total of 230 patients, aged 15–50 years, with intraoperatively confirmed perforated appendicitis, were enrolled using non-probability consecutive sampling. Patients with negative appendectomy or non-perforated appendix on operation, pregnant females, immune-compromized and DM were excluded. Participants were assigned to undergo either LA (Group A, n=115) or OA (Group B, n=115). Consultant surgeons performed all procedures with at least three years of post-fellowship experience. Primary outcomes included SSIs (tracked for four weeks postoperatively), operative time (minutes), hospital stay (days), and time to resume routine activities (days). Results: The mean age of patients in group A was 34.60 ± 7.77 years and in group B was 35.61 ± 8.17 years. Majority of the patients 127 (55.22%) were between 15 to 35 years of age. Out of 230 patients 153 (66.52%) were males and 77 (33.48%) were females with male to female ratio of 2:1. SSIs occurred in 4.35% of patients undergoing LA versus 11.30% in the OA group (p=0.049). LA had a significantly longer operative time (74 ± 15 vs. 50.9 ± 15 minutes, p<0.0001) but resulted in a shorter hospital stay (2.4 ± 0.6 vs. 3.7 ± 2.5 days, p=0.03). A highly significant difference existed between 2 groups in time taken to return to normal routine activities, less in group A (LA) with means 14.4±3.1 vs 18.1±3.3 days with p value 0.0001. LA remained superior in reducing wound infections overall. Conclusion: In patients with perforated appendicitis, laparoscopic appendectomy significantly lowers the risk of SSIs, shortens hospital stay, and facilitates an earlier return to daily activities, despite a moderately longer operative time.