Association between appendiceal stump closure method and post-operative bowel obstruction after laparoscopic...

Area of Science:

• Pediatric Surgery
• Gastrointestinal Surgery
• Surgical Outcomes

Background:

• Laparoscopic appendectomy is a common pediatric surgical procedure.
• Appendiceal stump closure methods, including surgical staplers and ligatures, vary among surgeons.
• Concerns exist that surgical staplers may increase the risk of small bowel obstruction (SBO).

Purpose of the Study:

• To investigate the association between appendiceal stump closure method (stapler vs. ligature) and the risk of SBO after laparoscopic appendectomy in children.
• To compare the incidence of SBO or reoperation within 30 days post-surgery between the two closure methods.
• To analyze the cost implications of different stump closure techniques.

Main Methods:

• A retrospective comparative study using the Pediatric Health Information System (PHIS) database.
• Included 49,191 patients aged 3-18 years who underwent laparoscopic appendectomy for appendicitis (2016-2020).
• Used multivariable regression to analyze the association between stump closure method and post-operative SBO or reoperation, adjusting for confounders.

Main Results:

• Surgical staplers were used in 72.75% of cases; early SBO or reoperation occurred in 1.33% of patients.
• No statistically significant difference in the odds of SBO or reoperation was found between stapler and ligature groups (OR 1.17).
• Complicated appendicitis was the strongest predictor of SBO/reoperation (OR 4.4); costs did not differ significantly between groups after adjustment.

Conclusions:

• Small bowel obstruction or reoperation following pediatric laparoscopic appendectomy is infrequent.
• Complicated appendicitis is the primary risk factor for post-operative SBO or reoperation.
• The choice of appendiceal stump closure method (stapler vs. ligature) does not appear to significantly impact SBO risk, with surgeon preference guiding practice.