Closure methods of the appendix stump for complications during laparoscopic appendectomy

Area of Science:

• Surgical Procedures
• Gastrointestinal Surgery
• Minimally Invasive Surgery

Background:

• Laparoscopic appendectomy is a common procedure, with appendix stump closure being critical to prevent complications.
• Methods for stump closure include traditional ligatures and mechanical devices, but the optimal choice is unclear.

Purpose of the Study:

• To compare all surgical techniques for appendix stump closure during laparoscopic appendectomy.

Main Methods:

• A meta-analysis of eight randomized controlled trials (RCTs) comparing mechanical devices (staplers, clips, electrothermal) versus ligatures (Endoloop, Roeder loop, intracorporeal knots).
• Data on complications, operating time, and hospital stay were extracted and analyzed.

Main Results:

• No significant difference in total, intraoperative, or postoperative complications between mechanical devices and ligatures (very low-quality evidence).
• Mechanical devices reduced total operating time by approximately 9 minutes but did not significantly decrease inpatient hospital stay.
• Insufficient data for reliable comparison of costs and postoperative pain/quality of life.

Conclusions:

• Current evidence is insufficient to recommend mechanical devices over conventional ligatures for appendix stump closure in uncomplicated appendicitis.
• The quality of available evidence is very low, limiting definitive conclusions on the superiority of any specific method.