One of the most common causes of acute abdominal pain in young adults is acute appendicitis (a painful medical condition, which means inflammation of the appendix) occurring in about 7-9% of the population aged between 10-30 years [1].

Chronic appendicitis can occur in some cases leading to mild episodes of abdominal pain relieved on its own; this occurs in about 1.5% of cases [2]. Suppose appendicitis is not treated at the proper time. In that case, it could burst, leading to peritonitis (in which the peritoneum will be inflamed) [3], leading to the formation of abscesses on or around it. If the inflammation is combined by decreased blood flow to the appendix, this can cause tissue injury and death (gangrenous appendicitis) [4].

As a result, appendectomy is one of the most common abdominal surgical procedures [5], performed either by open appendectomy, which has been the main treatment choice for the last century or by laparoscopic approach [6,7].

There are many advantages of laparoscopic appendectomy: Better-wound healing, less postoperative pain, better recovery, fewer hospital stays and better cosmetically [8,9,10].

While the disadvantages include; longer operative time, more cost, increased intra- abdominal abscesses [11,12].

A total of 90 Patients older than 12 years, attending AL-Yarmouk Teaching Hospital, at AL Kharkh Health Directorate, in Baghdad, for the period from January to March 2021, with acute appendicitis (investigated and diagnosed clinically, laboratory and by ultrasonography), were randomized to either open or laparoscopic appendectomy. Patients who were intended to go laparoscopic appendectomy then converted to open appendectomy were excluded from the study. Operative time was considered from starting to do the incision until complete wound closure-many post-ops. Complications were determined by asking the patients during their postoperative visits. Excel sheets did statistical analysis and a chi-square test was done to look for significant associations.

Most of the patients were aged 21-25 years, with a mean age of 25.33±8.435 in an open appendectomy and 22.97±6.775 in laparoscopic type.

Sex distribution was 32 male and 28 female in the first group, with a male to female ratio of 1.14 ∕1, while in the second group, there were 13 males and 17 females and a ratio of 0.76 ∕ 1 (Table 1).

Table 1: Demographic Distribution of the Participants

Table 2: Some Post-Operative Outcomes in Association with the Type of Operation

Table 3: Clinical Types of Appendixes

Table 2 shows the association between the type of operation and some post-operative outcomes. Most of them show significant association, such as the duration of oral and parenteral analgesia and minor complications postoperatively, which were more in cases of OA. 

Table 3 shows types of the appendix and clinical types; they were mostly of the acute type 48(73.8%) in cases of open appendectomy and retrocecal type 8(66.6%) in cases of laparoscopic appendectomy.

While for clinical type, the highest percentage was for peritonitis with 4 cases (100%) in OA and acutely inflamed type with 21 cases (41.1%) in LA.

Acute appendicitis must be considered in any patient presenting with acute abdominal pain. It is still the most common urgent intra-abdominal condition that needs surgical intervention [9], which could be performed either by open or laparoscopic appendectomy.

In our study, we are trying to compare the two techniques regarding some factors.

As for the age, there was no great difference between the two groups' means, 25.33±8.435 and 22.97±6.775, for open and laparoscopic approaches, respectively.

Most of the male and female groups enrolled in our study underwent open technique (maybe due to its lower cost in our country), despite the studies which showed that laparoscopic technique is safer, with faster returning to daily activity and lesser complications [13-19].

On the other hand, a new meta-analysis of randomized controlled trials showed that the two procedures have the same safety and effectiveness in managing acute appendicitis [20]. 

At the beginning of applying LA, it takes longer to perform [11,21,22], the same as found in our study and some other studies [23-25].

The difference was statistically significant regarding the use of oral and parenteral analgesia, which was less used in our LA patients, with similar findings in other studies [26,27].

Despite the different classification for returning to normal activity in different studies, there was a significant association between the type of operation and returning to daily activity, in favor of LA, in our study and these studies [7,27,21].

We found that minor complications following LA, such as paralytic ileus, nausea and vomiting, are less frequently reported [10,11,28], in addition to wound infection, which was also lower in LA, due to the technique performed (less size incision and delivery of the appendix through a port) [10,11,22,28-33].

Regarding major complications, there was no significant association between the occurrence of Intra-abdominal abscess and type of operation, which was found to be lower in LA, in similarity with other studies [24,34], which could be due to improved skills for laparoscopic techniques [35,36].

Regarding intraoperative types, there was no statistically observed evidence of association [37].

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