Laparoscopic Versus Open Appendectomy for the Treatment of Complicated Acute Appendicitis

Alireza Barband, Amir Mangouri, Changiz Gholipouri, Abasad Gharedaghi


Background and Objective: Acute appendicitis is one of the most common and at the same time lethal if not treated promptly. Failure to treat this medical condition in a timely manner then it can lead to major complications that endanger the patient’s health. In these cases, surgical treatment can be done in an open or laparoscopic method. Despite some limited studies comparing the results of these two therapies, there is still insufficient information in patients with this complicated situation. The aim of this study was to evaluate the results of these two therapies in patients with complicated acute appendicitis. Materials and Methods: In this randomized controlled clinical trial, 52 patients with complicated acute appendicitis in the laparoscopic surgery group and 56 patients in the open surgery group were studied. Primary outcomes in this study were duration of surgery and secondary outcomes including wound infection, intra-abdominal abscess, postoperative pain, miscarriage, hospitalization, and need for re-surgery that were compared between the two groups. Results: Both groups were matched for age (mean 31.0 years in laparoscopic surgery group, 30.5 years in open surgery group, p = 0.81) and gender (28 men in laparoscopic surgery group, 32 men in surgical group, p = 0.73). The mean duration of surgery in the laparoscopic group was significantly longer (mean 66.8 vs. 55.1 min, p <0.001). In contrast, mean duration of hospitalization (85.2 vs 98.6 hours, p <0.001) and mean postoperative pain severity (6.3 vs 7.2, p <0.001) was more significant high in open surgery group. In other cases there was no significant difference between the two groups. Conclusion: Although in surgical treatment of complicated acute appendicitis the duration of laparoscopic surgery is longer than the open method, but the duration of hospitalization and pain intensity in laparoscopic method is significantly reduced.


Appendicitis, Laparoscopic Surgery, Open Surgery

Full Text:



Hansen JB, Smithers BM, Schache D, Wall DR, Miller BJ, Menzies BL. Laparoscopic versus open appendectomy: prospective randomized trial. World journal of surgery. 1996;20(1):17-20; discussion 1.

Pedersen AG, Petersen OB, Wara P, Ronning H, Qvist N, Laurberg S. Randomized clinical trial of laparoscopic versus open appendicectomy. The British journal of surgery. 2001;88(2):200-5.

Katkhouda N, Mason RJ, Towfigh S. Laparoscopic versus open appendectomy: a prospective, randomized, double-blind study. Advances in surgery. 2006;40:1-19.

Tzovaras G, Baloyiannis I, Kouritas V, Symeonidis D, Spyridakis M, Poultsidi A, et al. Laparoscopic versus open appendectomy in men: a prospective randomized trial. Surgical endoscopy. 2010;24(12):2987-92.

Mohamed AA, Mahran KM. Laparoscopic appendectomy in complicated appendicitis: Is it safe? Journal of minimal access surgery. 2013;9(2):55-8.

Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appendectomy: a metaanalysis. Journal of the American College of Surgeons. 1998;186(5):545-53.

Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. The Cochrane database of systematic reviews. 2004(4):CD001546.

Pokala N, Sadhasivam S, Kiran RP, Parithivel V. Complicated appendicitis--is the laparoscopic approach appropriate? A comparative study with the open approach: outcome in a community hospital setting. The American surgeon. 2007;73(8):737-41; discussion 41-2.

Yau KK, Siu WT, Tang CN, Yang GP, Li MK. Laparoscopic versus open appendectomy for complicated appendicitis. Journal of the American College of Surgeons. 2007;205(1):60-5.

Shelton T, McKinlay R, Schwartz RW. Acute appendicitis: current diagnosis and treatment. Current surgery. 2003;60(5):502-5.

Lintula H, Kokki H, Vanamo K. Single-blind randomized clinical trial of laparoscopic versus open appendicectomy in children. The British journal of surgery. 2001;88(4):510-4.

Esposito C, Borzi P, Valla JS, Mekki M, Nouri A, Becmeur F, et al. Laparoscopic versus open appendectomy in children: a retrospective comparative study of 2,332 cases. World journal of surgery. 2007;31(4):750-5.

Menezes M, Das L, Alagtal M, Haroun J, Puri P. Laparoscopic appendectomy is recommended for the treatment of complicated appendicitis in children. Pediatric surgery international. 2008;24(3):303-5.

Cueto J, D'Allemagne B, Vazquez-Frias JA, Gomez S, Delgado F, Trullenque L, et al. Morbidity of laparoscopic surgery for complicated appendicitis: an international study. Surgical endoscopy. 2006;20(5):717-20.

Tate JJ. Laparoscopic appendicectomy. The British journal of surgery. 1996;83(9):1169-70.

Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults. A prospective study. Annals of surgery. 1995;221(3):278-81.

Krukowski ZH, Irwin ST, Denholm S, Matheson NA. Preventing wound infection after appendicectomy: a review. The British journal of surgery. 1988;75(10):1023-33.

Reid RI, Dobbs BR, Frizelle FA. Risk factors for post-appendicectomy intra-abdominal abscess. The Australian and New Zealand journal of surgery. 1999;69(5):373-4.

Alvarez C, Voitk AJ. The road to ambulatory laparoscopic management of perforated appendicitis. American journal of surgery. 2000;179(1):63-6.

Long KH, Bannon MP, Zietlow SP, Helgeson ER, Harmsen WS, Smith CD, et al. A prospective randomized comparison of laparoscopic appendectomy with open appendectomy: Clinical and economic analyses. Surgery. 2001;129(4):390-400.

Slim K, Pezet D, Chipponi J. Laparoscopic or open appendectomy? Critical review of randomized, controlled trials. Diseases of the colon and rectum. 1998;41(3):398-403.

Sauerland S, Lefering R, Holthausen U, Neugebauer EA. Laparoscopic vs conventional appendectomy--a meta-analysis of randomised controlled trials. Langenbeck's archives of surgery. 1998;383(3-4):289-95.

Garg CP, Vaidya BB, Chengalath MM. Efficacy of laparoscopy in complicated appendicitis. International journal of surgery. 2009;7(3):250-2.

Fukami Y, Hasegawa H, Sakamoto E, Komatsu S, Hiromatsu T. Value of laparoscopic appendectomy in perforated appendicitis. World journal of surgery. 2007;31(1):93-7.

Thomson JE, Kruger D, Jann-Kruger C, Kiss A, Omoshoro-Jones JA, Luvhengo T, et al. Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety. Surgical endoscopy. 2015;29(7):2027-32.

Garbutt JM, Soper NJ, Shannon WD, Botero A, Littenberg B. Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy. Surgical laparoscopy & endoscopy. 1999;9(1):17-26.

Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. The Cochrane database of systematic reviews. 2010(10):CD001546.

Piskun G, Kozik D, Rajpal S, Shaftan G, Fogler R. Comparison of laparoscopic, open, and converted appendectomy for perforated appendicitis. Surgical endoscopy. 2001;15(7):660-2.

Guana R, Lonati L, Garofalo S, Tommasoni N, Ferrero L, Cerrina A, et al. Laparoscopic versus Open Surgery in Complicated Appendicitis in Children Less Than 5 Years Old: A Six-Year Single-Centre Experience. Surgery research and practice. 2016;2016:4120214.

Ball CG, Kortbeek JB, Kirkpatrick AW, Mitchell P. Laparoscopic appendectomy for complicated appendicitis: an evaluation of postoperative factors. Surgical endoscopy. 2004;18(6):969-73.

Chung RS, Rowland DY, Li P, Diaz J. A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy. American journal of surgery. 1999;177(3):250-6.

Temple LK, Litwin DE, McLeod RS. A meta-analysis of laparoscopic versus open appendectomy in patients suspected of having acute appendicitis. Canadian journal of surgery Journal canadien de chirurgie. 1999;42(5):377-83.

Katsuno G, Nagakari K, Yoshikawa S, Sugiyama K, Fukunaga M. Laparoscopic appendectomy for complicated appendicitis: a comparison with open appendectomy. World journal of surgery. 2009;33(2):208-14.

Khiria LS, Ardhnari R, Mohan N, Kumar P, Nambiar R. Laparoscopic appendicectomy for complicated appendicitis: is it safe and justified?: A retrospective analysis. Surgical laparoscopy, endoscopy & percutaneous techniques. 2011;21(3):142-5.

Dimitriou I, Reckmann B, Nephuth O, Betzler M. Single institution's experience in laparoscopic appendectomy as a suitable therapy for complicated appendicitis. Langenbeck's archives of surgery. 2013;398(1):147-52.

So JB, Chiong EC, Chiong E, Cheah WK, Lomanto D, Goh P, et al. Laparoscopic appendectomy for perforated appendicitis. World journal of surgery. 2002;26(12):1485-8.

Senapathi PS, Bhattacharya D, Ammori BJ. Early laparoscopic appendectomy for appendicular mass. Surgical endoscopy. 2002;16(12):1783-5.

Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks S, et al. Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Annals of surgery. 2004;239(1):43-52.

Mancini GJ, Mancini ML, Nelson HS, Jr. Efficacy of laparoscopic appendectomy in appendicitis with peritonitis. The American surgeon. 2005;71(1):1-4; discussion -5.

Di Saverio S, Mandrioli M, Sibilio A, Smerieri N, Lombardi R, Catena F, et al. A cost-effective technique for laparoscopic appendectomy: outcomes and costs of a case-control prospective single-operator study of 112 unselected consecutive cases of complicated acute appendicitis. Journal of the American College of Surgeons. 2014;218(3):e51-65.



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

2013-2023 (CC-BY) Australian International Academic Centre PTY.LTD.

Advances in Bioscience and Clinical Medicine