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

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.