Clinical application research of internal traction-assisted suspended closure in endoscopic transcecal appendectomy

Endoscopic transcecal appendectomy (ETA) has gained increasing clinical adoption as a minimally invasive surgical approach. However, conventional appendiceal stump closure techniques present notable limitations due to their operational complexity. This technological constraint underscores the clinical need to develop optimized closure methodologies. In this study, we proposed an innovative "internal traction-assisted suspended closure (ITASC)" technique and conducted a multicenter retrospective comparative study to evaluate its clinical efficacy.

Data from patients who underwent ETA from December 2018 to March 2025 were included. This retrospective study evaluated key perioperative outcomes between the conventional closure cohort (n = 28) and the ITASC implementation group (n = 14). The primary outcome was the rate of successful closure. Secondary outcomes encompassed closure time, intraoperative blood loss, duration of postprocedural hospitalization and the incidence of postoperative adverse events.

Both groups achieved 100% closure success. No serious complications occurred with ITASC, whereas conventional sutures were associated with serious postoperative complications in 3/28 patients. ITASC significantly reduced closure time (12.29 vs. 18.29 min, p = 0.003) and lowered inflammatory markers: WBC (9.47 × 10⁹/L vs. 12.92 × 10⁹/L, p = 0.001) and neutrophils (7.21 × 10⁹/L vs. 10.18 × 10⁹/L, p = 0.003). Operation time and postoperative hospital time showed no significant differences (p > 0.05).

ITASC and traditional closure were equally safe and effective for ETA. However, ITASC demonstrated lower severe complication rates, attenuated postoperative infection, and significantly faster closure with reduced inflammation. No differences existed in total operation time or hospitalization. Large-sample studies are needed to validate long-term safety.