COMPARATIVE ANALYSIS ON LAPAROSCOPIC AND OPEN SURGERY IN MANAGEMENT OF ABDOMINAL CONDITIONS: A STUDY OF NATIONAL HOSPITAL ABUJA

1.1 Background to the Study The evolution of surgical techniques has significantly advanced the management of abdominal conditions globally. Among the most transformative innovations in this domain is laparoscopic surgery, a minimally invasive procedure introduced in the late 20th century that offers significant clinical advantages over conventional open surgery. Laparoscopic surgery, also known as minimally invasive surgery, is a modern surgical technique performed through small incisions using a laparoscope—a long, thin instrument with a high-resolution camera and light source. According to Vecchio et al. (2021), laparoscopic surgery involves the insufflation of the abdominal cavity with carbon dioxide to provide space for surgical manipulation, allowing surgeons to operate with precision via video-assisted imaging. This method is associated with several clinical advantages, including reduced intraoperative blood loss, lower postoperative pain, shorter hospital stays, and faster return to normal activities (Zhou et al., 2022). However, the procedure requires specialized equipment and training, and while complication rates are generally lower compared to open surgery, risks such as trocar injuries, organ perforation, and anesthesia-related issues remain present, though relatively rare. In contrast open surgery, involves making a large incision to directly access the target organ or region of the body. It is the traditional approach to abdominal surgery and remains widely practiced, especially in emergency cases or settings with limited laparoscopic infrastructure. As defined by Jamali and Soroush (2020), open surgery allows for tactile feedback and greater visibility for complex cases, which can be advantageous in managing extensive pathology. However, the larger incisions typically result in increased postoperative pain, greater risk of wound infection, longer hospital stays, and delayed recovery (Obiechina & Umego, 2021). While it may be the preferred method in complicated or trauma cases, advancements in minimally invasive techniques are gradually reducing its prevalence in elective abdominal surgeries. Across the developed world, laparoscopy has rapidly become a preferred modality due to its association with reduced post-operative pain, shorter hospital stay, and faster recovery times. These benefits have prompted healthcare systems in both high- and middle-income countries to integrate laparoscopic techniques into routine surgical care (Ogunbiyi et al., 2021). In Africa, however, particularly in Nigeria, the diffusion of laparoscopic surgery has been relatively slow due to factors such as high costs of equipment, inadequate training, and infrastructural constraints (Ojo & Balogun, 2023). Nevertheless, tertiary hospitals have made commendable strides in adopting laparoscopic procedures, especially in managing common abdominal conditions such as appendicitis, cholecystitis, perforated ulcers, and obstructed hernias. These facilities now provide a platform for comparing outcomes between laparoscopic and open surgeries in the Nigerian healthcare context. Comparatively, the debate on whether laparoscopic surgery significantly outperforms open surgery in terms of patient outcomes, cost-effectiveness, and complication rates remains relevant. While laparoscopic surgery is less invasive, open surgery is still commonly used, particularly in emergencies or where laparoscopy is unavailable. Numerous global studies (e.g., Yadav et al., 2020; Hasani et al., 2022) highlight better post-operative outcomes for laparoscopy, but localized Nigerian data remains sparse, necessitating contextual assessment. National Hospital Abuja, being a federal tertiary health institution, serves a diverse patient population and is equipped for both surgical approaches. Therefore, it is an ideal setting for an empirical comparative study to determine which modality delivers superior clinical outcomes for abdominal surgeries in a Nigerian context. The findings of this study could inform national surgical guidelines and resource allocation strategies. 1.2 Statement of the Problem Despite global advances and the availability of laparoscopic technology in select Nigerian hospitals, open surgery remains prevalent, raising concerns about whether optimal patient outcomes are being achieved. The problem lies in the limited empirical evidence from Nigerian hospitals comparing the two approaches across key performance indicators such as duration of surgery, post-operative complications, recovery time, and patient satisfaction. This gap makes it difficult for practitioners and policymakers to develop evidence-based surgical guidelines. Given the infrastructural and economic challenges faced by the Nigerian healthcare system, it is critical to determine whether laparoscopic surgery offers sufficient benefits to justify broader investment and training. Without such evidence, decisions on surgical methods risk being arbitrary or based on outdated practices. 1.3 Objectives of the Study The primary objective of this study is to compare the effectiveness of laparoscopic and open surgery in the management of abdominal conditions at National Hospital Abuja. Specifically, the study seeks to: 1. Assess the clinical outcomes (complication rates, recovery times, and duration of hospitalization) associated with laparoscopic and open surgery. 2. Evaluate intraoperative parameters such as duration of surgery and blood loss. 3. Analyze patient satisfaction and postoperative pain levels for both surgical approaches. 4. Identify constraints and facilitators to the adoption of laparoscopic surgery in the hospital. 1.4 Research Questions 1. What are the differences in post-operative recovery and complication rates between laparoscopic and open abdominal surgeries? 2. How do intraoperative parameters compare between the two surgical methods? 3. What is the level of patient satisfaction associated with laparoscopic versus open surgery? 4. What institutional factors affect the choice and outcome of surgical methods at National Hospital Abuja? 1.5 Significance of the Study This study is significant in its potential to inform surgical practice and policy in Nigeria. It will provide evidence-based insights on the comparative advantages and limitations of laparoscopic versus open surgery, guiding clinicians in decision-making and improving patient care. Furthermore, the findings may influence institutional investments in surgical infrastructure and the training of medical personnel, ultimately contributing to more efficient and modern surgical services in Nigeria. 1.6 Scope and Delimitation of the Study The study is limited to the surgical department of the National Hospital Abuja and focuses only on adult patients who underwent either laparoscopic or open abdominal surgeries within a specified period. It does not extend to pediatric cases or non-abdominal procedures. The comparative analysis is restricted to clinical outcomes, surgical parameters, and patient satisfaction within the hospital context.