Background: Various techniques can be used for the closure of the appendiceal stump in laparoscopic appendectomy, although no consensus exists on the optimum approach.
Objectives: The present study was conducted to compare three different stump closure techniques in cases of complicated appendicitis.
Methods: A total of 172 patients who underwent laparoscopic appendectomy for complicated appendicitis were selected for conducting the present retrospective cohort study. The patients were divided into three groups according to the appendiceal stump closure technique: Hem-o-lok clips; extracorporeal knots which were pushed into the abdomen; and laparoscopic knots which were tied manually within the abdomen. The three groups of patients were compared for demographic and clinical characteristics as well as follow-up data.
Results: A total of 85 patients were in Group 1, 43 patients in Group 2, and 44 patients in Group 3. The most common surgical finding was a necrotic appendix in all three groups (67.1% vs. 81.4% vs. 68.2%; p: 0.448). The rate of drain use (42.4% vs. 34.9% vs. 31.8%; p: 0.455) and the readmission rates (10.6% vs. 14% vs. 11.4%; p: 0.178) were also similar in all groups. The median postoperative hospital stay was 2 days in all groups.
Conclusion: No superiority was identified in any of the approaches to stump closure for the laparoscopic treatment of complicated appendicitis cases. All three techniques can be used safely. Accordingly, the technique should be selected based on the assessment of the surgeon, patient’s characteristics, and cost.
- Jaschinski T, Mosch CG, Eikermann M, Neugebauer EA, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2018 28;11(11): CD001546. doi: 10.1002/14651858.CD001546.pub4. [PMID: 30484855].
- Makaram N, Knight SR, Ibrahim A, Patil P, Wilson MSJ. Closure of the appendiceal stump in laparoscopic appendectomy: A systematic review of the literature. Ann Med Surg . 2020;57:228-235. doi: 10.1016/j.amsu.2020.07.058. [PMID: 32802324].
- Ureyen O, Tan S, Dadali E, Yildirim M, İlhan E. Hem-o-lok clips versus intracorporeal knotting for the closure of the appendix stump in laparoscopic appendectomy: A prospective randomized study. Ulus Travma Acil Cerrahi Derg. 2020; 26(3):84-8. doi: 10.14744/tjtes.2019.02248. [PMID: 32436964].
- Ferahman S, Donmez T, Yilmaz S, Akbulut S, Sürek A, Kabuli HA, et al. Comparison of stump burying using laparoscopic and open methods in complicated acute appendicitis. Med J Bakirkoy. 2020; 16:336-42. doi:10.5222/BMJ.2020.59254.
- Escolino M, Becmeur F, Saxena A, Till H, Holcomb GW 3rd, Esposito C. Endoloop versus endostapler: what is the best option for appendiceal stump closure in children with complicated appendicitis? Results of a multicentric international survey. Surg Endosc. 2018;32(8):3570-75. doi: 10.1007/s00464-018-6081-8.
- Ceresoli M, Tamini N, Gianotti L, Braga M, Nespoli L. Are endoscopic loop ties safe even in complicated acute appendicitis? A systematic review and meta-analysis. Int J Surg. 2019;68:40-7. doi: 10.1016/j.ijsu.2019.06.011.
- Caglià P, Tracia A, Spataro D, Borzì L, Lucifora B, Tracia L, et al. Appendix stump closure with endoloop in laparoscopic appendectomy. Ann Ital Chir. 2014;85(6):606-9. [PMID: 25712546]
- Vuille-Dit-Bille R, Soll C, Mazel P, Staerkle RF, Breitenstein S. Appendiceal stump closure with polymeric clips is a reliable alternative to endostaplers. J Int Med Res. 2020;48(1):a 300060519856154. doi: 10.1177/0300060519856154. [PMID: 31234666].
- Antoniou SA, Mavridis D, Hajibandeh S, Hajibandeh S, Antoniou GA, Gorter R, et al. Optimal stump management in laparoscopic appendectomy: A network meta-analysis by the Minimally Invasive Surgery Synthesis of Interventions and Outcomes Network. Surgery. 2017;162(5):994-1005. doi: 10.1016/j.surg.2017.07.013. [PMID: 28864100]
- Mannu GS, Sudul MK, Bettencourt-Silva JH, Cumber E, Li F, Clark AB, Loke YK. Closure methods of the appendix stump for complications during laparoscopic appendectomy. Cochrane Database Syst Rev. 2017;11(11):CD006437. doi: 10.1002/14651858.CD006437.pub3. [PMID: 29190038].
- Delibegović S, Mehmedovic Z. The influence of the different forms of appendix base closure on patient outcome in laparoscopic appendectomy: a randomized trial. Surg Endosc. 2018;32(5):2295-9. doi: 10.1007/s00464-017-5924-z. [PMID: 29098432].
- Mayir B, Ensari CÖ, Bilecik T, Aslaner A, Oruç MT. Methods for closure of appendix stump during laparoscopic appendectomy procedure. Ulus Cerrahi Derg. 2015;31(4):229-31. doi: 10.5152/UCD.2015.2768. [ PMID: 26668532]].
- Galatioto C, Guadagni S, Zocco G, Mazzilo M, Bagnato C, Lippolis PV, et al. Mesoappendix and appendix stump treatment in laparoscopic appendectomy: a retrospective study in 1084 patients. Ann Ital Chir. 2013 ;84(3):269-74. [PMID: 23856524].
- Gunes ME, Gemici E, Donmez T. Comparison of laparoscopic embedding technique and other techniques for appendiceal stump closure. Turk J Colorectal Dis. 2019;29(3):121–6. doi: 10.4274/tjcd.galenos.2019.78857