Validation of appendiceal stump invagination in laparoscopic appendectomy

Area of Science:

• Gastroenterology
• Surgical Innovation
• Clinical Outcomes Research

Background:

• The necessity of appendiceal stump invagination after laparoscopic appendectomy for acute appendicitis is debated.
• Existing literature lacks consensus on whether stump invagination impacts patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of appendiceal stump invagination versus noninvagination in patients undergoing laparoscopic appendectomy for acute appendicitis.
• To assess the impact of stump invagination on short-term and long-term surgical outcomes.

Main Methods:

• A retrospective analysis of 327 patients who underwent laparoscopic appendectomy between 2012 and 2020.
• Comparison of perioperative variables and surgical outcomes between invagination and noninvagination groups.
• Propensity score-matched analysis (PSM) to mitigate bias between groups.

Main Results:

• The noninvagination group initially presented with more severe inflammation, intra-abdominal contamination, older age, higher BMI, and poorer ASA status.
• Despite initial differences, PSM analysis revealed no significant variations in surgical site infection, intra-abdominal abscess, severe postoperative complications (Clavien-Dindo ≥IIIa), or hospital stay.
• Postoperative adhesive ileus rates were comparable between the invagination and noninvagination groups during follow-up.

Conclusions:

• Appendiceal stump invagination is not essential for preventing short- and long-term complications following laparoscopic appendectomy.
• The method of appendiceal stump dissection, including laparoscopic endostapler use, does not correlate with the incidence of postoperative adhesive ileus.