Endoscopic Management of Appendiceal Stump Lesions via Transcolonic Access: A Safe and Feasible Minimally Invasive...

Transcolonic endoscopic appendectomy is an emerging minimally invasive alternative to traditional appendectomy, offering potential benefits such as reduced postoperative pain, faster recovery, and avoidance of external incisions. The variable anatomical location of the appendix, however, influences both the surgical approach and technical difficulty. The appendiceal stump-defined as the residual portion of the appendix after prior appendectomy-poses a unique challenge, as the main body of the appendix has already been removed. This study aimed to evaluate the feasibility, safety, and efficacy of transcolonic endoscopic appendectomy for the removal of appendiceal stump lesions.

This retrospective study included patients who underwent the procedure between December 2020 and December 2024 after prior appendectomy for appendiceal remnant lesions. The primary outcome was technical success; secondary outcomes included postoperative complications, hospital stay, and recurrence.

Nine patients (mean age 60.7 years; 4 males, 5 females) were included. Lesion size averaged 1.34 cm. Complete en bloc resection was achieved in all cases. Mean operative time was 70 min, with fasting and hospitalization durations of 3.4 and 5.8 days, respectively. No postoperative complications occurred, and 3-month colonoscopy showed no residual lesions or recurrence.

Transcolonic endoscopic appendectomy for appendiceal stump lesions is a safe and effective minimally invasive treatment option within experienced endoscopic centers. Due to their anatomical simplicity, these lesions represent a straightforward indication, making the procedure suitable as an entry-level application for endoscopists. Further investigation and structured training programs are warranted to assess long-term outcomes and broaden the generalizability of this technique.