Global trends and institutional experience with laparoscopic and open appendectomy for complicated acute appendicitis (2018 – september 2025)

Introduction: Acute appendicitis remains one of the most common surgical emergencies, while its complicated forms continue to pose a significant clinical challenge. Over the past decades, minimally invasive techniques have profoundly changed the management paradigm of the disease, although in cases of complicated appendicitis (perforation, gangrene, abscess, or peritonitis) the choice of surgical approach remains a matter of debate.Materials and Methods: A retrospective analysis was conducted on 124 patients with acute appendicitis, of whom 102 (82.3%) had complicated disease, treated at the Clinic of General and Hepatopancreatobiliary Surgery, Alexandrovska University Hospital, during the period 2018–September 2025. Clinical presentation, type of surgical intervention (open appendectomy, laparoscopic appendectomy, right hemicolectomy), postoperative complications, and length of hospital stay were analyzed.Results: Open appendectomy was performed in 83.1% of patients, laparoscopic appendectomy in 12.1%, and right hemicolectomy in 4.8%. By 2025, laparoscopic procedures accounted for 54% of all appendectomies. The mean hospital stay was significantly shorter in the laparoscopic group (5.2 vs. 7.8 days; p<0.05), with no difference in complication rates between the two approaches.Conclusion: Laparoscopic appendectomy is increasingly established as the method of choice not only for uncomplicated but also for selected cases of complicated acute appendicitis. The data from our institution confirm its safety, improved postoperative recovery, and shorter hospital stay with comparable morbidity rates.