MINIMALLY INVASIVE TECHNIQUES IN APPENDECTOMY: A COMPARATIVE STUDY

Abstract

Objective: Acute appendicitis was one of the most common general surgical emergencies managed at our tertiary care hospital in Karachi, Pakistan. Both open appendectomy (OA) and laparoscopic appendectomy (LA) were routinely performed. This study compared LA with OA in terms of recovery time, postoperative pain, complication rates, and cost-effectiveness within a high-volume urban surgical center.

Methods: A comparative surgical study was conducted in the Department of General Surgery at a major tertiary care teaching hospital in Karachi. Consecutive adult patients presenting with clinical and radiological evidence of acute appendicitis underwent either OA or LA according to surgeon expertise and patient preference. Standardized perioperative protocols and antibiotic regimens were used across groups. Primary outcomes included postoperative length of hospital stay and time to return to normal activities. Secondary outcomes comprised postoperative pain scores at 24 and 48 hours, surgical site infection (SSI), intra-abdominal abscess, 30-day readmission, reoperation, and direct hospital costs. Statistical significance was set at p < 0.05.

Research Type: Surgical Research

Results: LA demonstrated shorter postoperative hospitalization and earlier return to normal activity compared with OA. Patients in the LA cohort experienced lower postoperative pain scores and required fewer opioid doses. SSI rates were significantly lower in the LA group, whereas major complications and reoperation rates were comparable. Operative costs for LA were higher; however, overall hospitalization expenses and indirect productivity losses were reduced due to shorter inpatient stay and faster recovery.

Conclusion: In the Karachi tertiary care context, LA provided superior recovery metrics, lower wound morbidity, and comparable major complication risks relative to OA. When laparoscopic resources and trained personnel were available, LA represented a cost-effective operative strategy for managing acute appendicitis and should be prioritized as the preferred surgical approach.