Laparoscopic versus open appendectomy for acute appendicitis in Sub-Saharan Africa

Temitomi Jane Oyedele; Syed Hasham Ali; Abigail Oghenefejiro Asini; Adepeju Anuoluwa Agunbiade; Komolafe Praise Dolapo; Idris Sandra Olufunmilayo; Adetola Emmanuel Babalola; Nicholas Aderinto

doi:10.1097/MS9.0000000000004445

Laparoscopic versus open appendectomy for acute appendicitis in Sub-Saharan Africa

Ann Med Surg (Lond). 2025 Nov 27;88(1):728-735. doi: 10.1097/MS9.0000000000004445. eCollection 2026 Jan.

Authors

Temitomi Jane Oyedele¹, Syed Hasham Ali², Abigail Oghenefejiro Asini³, Adepeju Anuoluwa Agunbiade¹, Komolafe Praise Dolapo¹, Idris Sandra Olufunmilayo⁴, Adetola Emmanuel Babalola⁵, Nicholas Aderinto⁶

Affiliations

¹ Department of Medicine and Surgery, Bowen University, Iwo, Nigeria.
² Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
³ Department of Medicine and Surgery, Babcock University, Ogun, Nigeria.
⁴ Department of Medicine and Surgery, Afe Babalola University, Ado Ekiti, Nigeria.
⁵ Department of Medicine and Surgery, Kornberg School of Dentistry, Temple University, Philadelphia, USA.
⁶ Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.

Abstract

Background: Acute appendicitis remains a leading cause of emergency surgery globally. While laparoscopic appendectomy (LA) has become the preferred technique in high-income countries due to reduced postoperative complications and shorter recovery times, its adoption in Sub-Saharan Africa is limited by resource constraints. This systematic review and meta-analysis evaluates the safety, feasibility, and cost-effectiveness of LA compared to open appendectomy (OA) in this region.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted across PubMed/MEDLINE, Cochrane Library, AJOL, Scopus, Embase, and Web of Science from database inception to July 2025. Eligible studies included original research comparing LA and OA for acute appendicitis in Sub-Saharan Africa, with outcomes such as surgical site infection (SSI), operative time, hospital stay, and costs.

Results: LA significantly reduced SSI risk [risk ratio 0.40, 95% confidence interval (CI): 0.23-0.69, P = 0.001, I ² = 0%] and hospital stay [mean defference (MD) 1.32 days, 95% CI: 1.64-0.99, P < 0.00001, I ² = 86%) compared to OA across 452 and 521 patients, respectively. Operative time was longer with LA (MD 13.79 minutes, 95% CI: 7.23-20.35, P < 0.0001, I ² = 78%). Cost data from two studies were inconclusive, with OA being less expensive in one (P < 0.001) and LA showing a borderline advantage in another (P = 0.049), with no significant difference in theatre costs (USD 634.92 versus USD 589.20, P = 0.264).

Conclusions: LA offers significant safety and efficiency benefits over OA for acute appendicitis in Sub-Saharan Africa.

Keywords: Africa; appendectomy; laparoscopy.