Laparoscopic vs open appendectomy in children: postoperative outcomes and cost analysis
Submission: 05 December 2025 | Acceptance: 29 December 2025 | Publication: 28 January 2026
1Dr.Mukarram Mustajab, Dr. Umar Hayat2, Dr Farhat Bano3, Dr Nisar Ahmad Khan4, Dr Talat Shahzad5, Nadia Salam6
- Consultant general surgeon gajju khan medical college / MTI Bacha khan medical complex, Swabi.
- Masters in Pediatric surgery, Consultant Pediatric surgeon, Services hospital Lahore.
- Associate professor surgery SMBBMC (Shaheed Mohtarma Benazir Bhutto Medical College) Lyari.
- Consultant surgeon Ayub teaching hospital Abbottabad.
- Assistant Professor surgery Women Medical College, Abbottabad.
- Hospital Avicenna Medical and Dental College.
Abstract
Background:
Acute appendicitis is one of the most common surgical emergencies in children. Both laparoscopic appendectomy (LA) and open appendectomy (OA) are widely used, yet there is ongoing debate regarding their comparative effectiveness, postoperative outcomes, and cost implications in pediatric populations.
Objective:
To compare postoperative outcomes, recovery, and hospital costs between laparoscopic and open appendectomy in children.
Methods:
A comparative observational study was conducted on 120 children aged 2–16 years undergoing appendectomy for acute appendicitis. Patients were divided into two groups: laparoscopic (n=60) and open appendectomy (n=60). Demographic data, operative time, length of hospital stay, postoperative complications, analgesic requirements, time to return to normal activities, and total hospital costs were recorded. Statistical analysis was performed using SPSS v25, with p < 0.05 considered significant.
Results:
The mean operative time was longer in the LA group (55.4 ± 12.6 minutes) than in the OA group (48.2 ± 10.9 minutes, p = 0.01). LA was associated with shorter hospital stays (2.3 ± 0.8 vs 3.9 ± 1.2 days, p < 0.001), lower postoperative pain, and fewer complications (10% vs 25%, p = 0.04). Time to return to normal activities was significantly shorter in the LA group (6.2 ± 1.9 vs 10.4 ± 2.8 days, p < 0.001). However, the mean total hospital cost was higher for LA (PKR 78,500 ± 8,200) compared to OA (PKR 62,300 ± 7,400, p < 0.001).
Conclusion:
Laparoscopic appendectomy in children offers better postoperative outcomes, faster recovery, and lower complication rates than open appendectomy, though it is associated with higher hospital costs. Clinical decision-making should consider patient condition, surgeon expertise, and resource availability.