2025, Vol. 7, Issue 2, Part B

Background: While laparoscopic appendectomy (LA) is widely adopted, its immunomodulatory advantages in low-resource settings remain poorly characterized. This first-of-its-kind Iraqi study integrates clinical outcomes with serial inflammatory biomarker profiling to provide a biological rationale for LA adoption.

Methods: A prospective cohort study was conducted at Al-Zahraa Teaching Hospital, Wasit (2022). 180 patients with acute appendicitis were alternately assigned to LA (n=90) or OA (n=90). Clinical parameters (pain, ambulation, hospital stay) were recorded. Serum CRP, IL-6 levels were measured preoperatively and at 24h/72h postoperatively using standardized ELISA and immunoturbidimetry assays. Statistical analysis employed SPSS v26.

Results: LA was associated with significantly lower postoperative pain (p<0.001), earlier ambulation (8.2 vs. 14.6 hrs; p=0.002), and shorter hospitalization (1.8 vs. 3.4 days; p<0.001). Operative time was longer in LA (48.2 vs. 42.1 min; p=0.03). Critically, LA elicited a significantly attenuated inflammatory response as measured by CRP at 24h (42.3 vs. 89.7 mg/L; p<0.001) the key practical biomarker available in our setting. Strong correlations linked CRP elevation with prolonged hospital stay (r=0.78) and delayed ambulation (r=0.71).

Conclusion: Laparoscopic appendectomy enhances clinical recovery and mitigates surgery-induced systemic inflammation, as practically evidenced by CRP reduction. This provides a biological and operational rationale for prioritizing LA in Iraq, aligning surgical practice with principles of Enhanced Recovery after Surgery (ERAS) using available, routine biomarkers and clinical metrics.