Appendiceal stump closure in laparoscopic appendectomy: one endoloop vs. two endoloops vs. two endoclips-does it...

Area of Science:

• Surgical innovation in appendectomy procedures.
• Comparative analysis of surgical techniques.

Background:

• Appendiceal stump leak is a rare complication after laparoscopic appendectomy.
• Various methods exist for appendiceal stump closure, necessitating comparative outcome analysis.

Purpose of the Study:

• To compare the postoperative outcomes of three distinct appendiceal stump closure methods: single endoloop (1EL), double endoloop (2EL), and double endoclip (2EC).

Main Methods:

• Retrospective study of 733 patients undergoing laparoscopic appendectomy for acute appendicitis between January 2018 and June 2020.
• Data collected included patient demographics, pre-operative details, surgical technique, operative findings, and postoperative complications.
• Comparison of outcomes based on stump closure method: 1EL (n=360), 2EL (n=300), and 2EC (n=73), with all groups utilizing LigaSure for resection.

Main Results:

• No appendiceal stump leaks were reported across all groups.
• Postoperative intra-abdominal abscess rates were 1% (1EL), 1% (2EL), and 0% (2EC) (p=0.43).
• Overall complication rates were 4% (1EL), 3% (2EL), and 0% (2EC) (p=0.15), with significantly shorter operative times for 1EL and 2EC compared to 2EL (p<0.01).

Conclusions:

• No appendiceal stump closure method demonstrated clear clinical superiority.
• Given the low complication rates, cost-effectiveness emerges as a key factor in method selection.
• The single endoloop technique offers substantial cost reduction and may be advisable for medical centers to consider.