Comparison of stump closure techniques during laparoscopic appendectomies for complicated appendicitis – results from Pol-LA (Polish laparoscopic appendectomy) multicenter large cohort study

Abstract

Background: In general, the three main options for stump closure in laparoscopic appendectomy are clips, endoscopic staplers and endoloops. However, there is no gold standard, especially regarding complicated acute appendicitis which is generally associated with worse outcomes.

Objectives: We aimed to assess the outcomes of different stump closure techniques during laparoscopic appendectomies for complicated appendicitis

Methods: Our multicenter observational study of 18 surgical units assessed the outcomes of 1269 laparoscopic appendectomies for complicated appendicitis that used the three main stump closure techniques: clips, staplers and endoloops. Groups were compared in terms of peri- and postoperative outcomes.

Results: Staplers were superior in terms of overall morbidity (9.79 vs. 3.29% vs. 7.41%, p = .017) and length of stay (4 vs. 3 vs. 4 days, p < .001) respectively for clips, staplers and endoloops. However, no differences in major complication rates, postoperative intraabdominal abscess formation, reintervention rates and readmission rates were found.

Conclusion: Although our results show some clinical benefits of staplers for appendix stump closure, they are based on a non-randomized group of patients and are therefore prone to selection bias. Further well-designed trials taking into consideration not only the clinical benefits, but also, the economic aspects of the surgical treatment of complicated acute appendicitis are needed to confirm our results.

Keywords:

• Appendicitis
• laparoscopic appendectomy
• stump closure
• complications

Informed consent, ethical approval and human rights

The study was observational in nature, informed consent and formal approval by a local ethics committee was not necessary. The data was completely anonymized, and no patient or hospital information was collected in the database. The study protocol was approved by the board of the Videosurgery Chapter of the Association of Polish Surgeons, and the study was conducted under its supervision. All procedures have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments (Fortaleza).

Disclosure statement

No potential conflict of interest was reported by the authors.