การเปรียบเทียบผลลัพธ์การผ่าตัดไส้ติ่งอักเสบระหว่างการผ่าตัดผ่านกล้องและการผ่าตัดแบบเปิดในโรงพยาบาลทองผาภูมิ จังหวัดกาญจนบุรี

Boonyarit Thongphisitsombat

Authors

Boonyarit Thongphisitsombat Department of Surgery, Thongphaphum Hospital, Kanchanaburi

Keywords:

Open appendectomy, Laparoscopic appendectomy, Thailand, Length of stay, Community hospital

Abstract

Background: Laparoscopic appendectomy (LA) is one of the standard treatments for uncomplicated appendicitis in tertiary hospitals, but data from rural community hospitals in Thailand remain limited.

Objective: This study aimed to compare surgical outcomes between LA and open appendectomy (OA) at Thong Pha Phum Hospital, Kanchanaburi.

Methods: This cohort study reviewed medical records of patients aged 12 years and older who underwent appendectomy between October 2024 and March 2026 (n=195), with 84 in the LA group and 111 in the OA group. The primary outcome was postoperative length of hospital stay (LOS, hours). Secondary outcomes included operative time, VAS pain score at post-op day 1, estimated blood loss (EBL), and pre-operative CT scan rate. Severity of appendicitis was controlled as a confounder using multivariable linear regression.

Results: LOS did not differ significantly between groups (LA: median 38.7 hr [IQR 34.9–45.8] vs OA: 38.5 hr [IQR 26.1–51.8]; p=0.504). The LA group had significantly lower day-1 VAS pain scores (median 2.2 vs 3.4; p<0.001) and less blood loss (median 5 vs 10 mL; p=0.029) but longer operative time (median 48 vs 40 min; p=0.003). Pre-operative CT scan rate (25.0% vs 29.7%; p=0.569), major complication and readmission rates were comparable. Severity of appendicitis was the strongest predictor of LOS (β=+30.2 hr per severity level; p<0.001).

Conclusion: LA at a rural Thai community hospital had comparable safety and hospital stay versus OA, with slightly less blood loss. Although LA patients reported lower pain scores, they also received local anaesthetic wound infiltration that OA patients did not, so this cannot be attributed to the surgical approach alone. The absence of an LOS difference suggests that disease severity and postoperative management influence LOS more than surgical approach in this setting.

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