Laparoscopic Appendectomy Exhibits Safety and Efficiency Advantages Over Open Appendectomy in New Study
Nigeria: Researchers have found in a new study that laparoscopic appendectomy provides clear safety and efficiency benefits compared with open appendectomy for patients with acute appendicitis in Sub-Saharan Africa. It is associated with fewer postoperative complications, reduced wound infections, shorter hospital stays, and quicker return to normal activities, while maintaining comparable mortality rates. These findings support wider adoption of laparoscopic approaches, even in resource-limited settings.
Acute appendicitis remains one of the most common surgical emergencies worldwide. Although laparoscopic appendectomy is widely practiced in high-income countries, its use in Sub-Saharan Africa has been limited by constraints related to infrastructure, surgical expertise, and cost. To assess whether the benefits seen elsewhere also apply in this region, researchers conducted a systematic review and meta-analysis comparing laparoscopic and open appendectomy outcomes.
Published in Annals of Medicine & Surgery, the study was led by Jane Temitomi Oyedele from Bowen University, Nigeria, and colleagues. Following PRISMA guidelines, the authors searched major international and regional databases, including PubMed/MEDLINE, the Cochrane Library, African Journals Online, Scopus, Embase, and Web of Science, covering studies published up to July 2025. Eligible studies directly compared laparoscopic and open appendectomy for acute appendicitis in Sub-Saharan Africa.
The following were the key findings:
- Five retrospective studies, including a total of 973 patients, were analyzed.
- Laparoscopic appendectomy was associated with a significantly lower risk of surgical site infections, showing an approximate 60% reduction compared with open appendectomy.
- Patients treated with the laparoscopic approach had shorter hospital stays, with discharge occurring about 1.3 days earlier on average.
- The reduced length of hospitalization suggests faster postoperative recovery and decreased burden on hospital resources.
- Laparoscopic appendectomy was associated with longer operative times, averaging nearly 14 minutes more than open surgery.
- The longer operative duration was attributed to limited availability of laparoscopic equipment, differences in surgeon expertise, and the learning curve for minimally invasive techniques in resource-limited settings.
- Cost outcomes varied across studies, with one reporting lower overall costs for open appendectomy and another indicating a slight cost advantage for laparoscopic surgery.
- Operating theatre costs were comparable between laparoscopic and open appendectomy.
- Overall, economic differences appeared to be influenced more by local healthcare systems and postoperative care costs than by the surgical approach itself.
The authors noted several limitations, including the retrospective design of all included studies and the overrepresentation of Nigerian data, which may limit applicability across the diverse healthcare settings of Sub-Saharan Africa. High variability in operative time and hospital stay also reflected differences in local infrastructure and practice patterns.
Overall, the study demonstrates that laparoscopic appendectomy offers significant clinical advantages over open surgery in Sub-Saharan Africa, particularly in reducing wound infections and shortening hospital stays. Despite longer operative times and variable cost findings, the results support broader implementation of laparoscopic techniques, alongside investments in training and infrastructure, to improve surgical outcomes in the region.
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