Is There An Ideal Stump Closure Technique In Laparoscopic Appendectomy?

Background: There is no standard routine closure technique in the management of appendiceal stump. Therefore, the ideal method should be determined based on the condition of the radix of the appendix.

Aim: The aim of this study was to evaluate appendiceal stump closure methods in patients undergoing laparoscopic appendectomy due to acute appendicitis.

Materials And Methods: The retrospective study included 196 patients who underwent laparoscopic appendectomy due to the diagnosis of acute appendicitis at Gazipasa State Hospital, Golhisar State Hospital, and Isparta State Hospital between 2009 and 2013. The methods performed for the closure of the appendiceal stump included stapler closure technique (Group I), ENDOLOOP® (Johnson & Johnson Inc., New Brunswick, New Jersey) technique (Group II), Hem-o-lok® (Teleflex®, Limerick, Pennsylvania) clip (Group III), and handmade endo-loop technique (Group IV). The groups were compared in terms of duration of surgery, length of hospital stay, postoperative pain, complication rates, and cost of treatment.

Results: No significant difference was observed among the groups in terms of patient characteristics. In eight patients, laparoscopic appendectomy was converted to open surgery due to various reasons. Mean length of hospital stay was two days in all of the groups that underwent laparoscopic appendectomy. No significant difference was found among the groups in terms of duration of surgery, complications, and postoperative analgesic requirement, but a significant difference was observed in terms of the cost of treatment.

Conclusions: We suggest that the handmade endo-loop technique is a safe, applicable, and cost-effective method to be used in the closure of appendiceal stump.