Closure of the Appendiceal Stump in Laparoscopic Appendectomy: A Comparison of Approaches to Complicated Appendicitis

Abstract

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.