O056 The impact of surgical risk factors on the development of stump appendicitis

Abstract

Abstract Introduction Stump appendicitis (SA) is a post-operative complication where inflammation occurs in the residual appendix following incomplete excision. Diagnosis is delayed due to the history of appendectomy, leading to a higher risk of complications such as perforation and peritonitis. This study aimed to investigate the incidence of SA and the surgical risk factors contributing to its development. Methods A literature review was conducted using Ovid Medline and Embase to evaluate the literature surrounding SA. A retrospective study was conducted at our centre to investigate the incidence of SA between June 2012 and June 2022. Results Literature review revealed 43/12,989 (0.33%) patients with SA. In the local cohort of 5401 patients who underwent appendectomy or right hemicolectomy for appendicitis, 15 developed SA (0.28%). Laparoscopic appendectomy was identified as a risk factor, with 66.67% of SA patients in Cardiff undergoing laparoscopic surgery for their primary appendicitis. Complicated primary appendicitis was reported in 53.33% of SA patients compared to 19.33% of the wider cohort. An appendicolith was present in 33.33% of SA patients compared to 12.11% of the total cohort. Residual stump length above 1.5cm was also acknowledged as a risk factor with a stump length ≥1.5cm reported in all local SA patients. Conclusion SA is associated with modifiable and non-modifiable risk factors. Care should be taken to identify the appendiceal base clearly at primary operation. Complicated appendicitis and the limitations of laparoscopic appendectomy present challenges in identifying the appendiceal base, thus contributing to the development of SA.