Laparoscopic vs conventional open surgery in appendicitis: where are we standing?

Appendicitis is one of the most frequent indications for surgical intervention, mostly in the pediatric population and, to a lesser degree, in adults. Conventionally, the surgical approach to appendicitis has been the gold standard for over a century, providing the highest success ratio. However, as with every surgical procedure, it may have complications. The technique for appendectomy has evolved in the past decades to decrease the incidence of complications, resulting in two great variants: open appendectomy (OAP) and laparoscopic appendectomy (LAP). Several aspects remain controversial when comparing these alternatives, including adverse events, pain scores, length of hospital stay, recovery time, and costs. Current evidence suggests that LAP has been widely adopted, providing great results. However, some authors have stated that the associated complications do not outweigh the inherent risks, speaking particularly of the IAA. Nonetheless, current, high-quality evidence reports that LAP and OAP are almost equally safe in most scenarios, with a slight tilt in the benefits balance towards the LAP. The lower incidence of SSI, shorter length of stay, lower pain scores, and faster recovery more than make up for the marginally higher cost. Given this scenario, several studies have compared these alternatives. This review aims to compare the complication rates and associated costs of OAP vs. LAP to provide a clear conclusion as to which is the best alternative to treat appendicitis