Outcomes of appendicitis in children: open vs laparoscopic approach

Abstract

Background: Acute appendicitis is a common surgical emergency in children. While open appendectomy has been traditionally practiced in Pakistan, laparoscopic appendectomy is increasingly being adopted due to its minimally invasive nature. 

Objective: To compare the postoperative outcomes of open versus laparoscopic appendectomy in pediatric patients with acute appendicitis.

Methodology: This comparative cross-sectional study was conducted at the Surgical Unit DHQ Teaching Hospital Mardan KPK from March 2024 to March 2025. including 168 children aged 5–15 years diagnosed with acute appendicitis. Patients were divided into two groups: Group A (open appendectomy) and Group B (laparoscopic appendectomy). Demographic data, operative findings, postoperative complications, length of hospital stay, and time to functional recovery were recorded.  Results: Out of the 168 patients, 94 (56.0%) underwent open appendectomy and 74 (44.0%) underwent laparoscopic appendectomy. The laparoscopic group had a longer mean operative time (p < 0.001) but experienced significantly lower postoperative pain, fewer wound infections, shorter hospital stay, and earlier return to normal activities (all p < 0.001). Intra-abdominal abscess formation was slightly higher in the laparoscopic group, though not statistically significant (p > 0.05). No mortality was observed in either group.

Conclusion: Laparoscopic appendectomy demonstrated superior postoperative recovery outcomes compared with open appendectomy in children, despite longer operative duration. Its wider adoption in pediatric surgical practice in Pakistan may improve patient-centered outcomes, provided adequate resources and surgical expertise are available.