Proper use of appendiceal stump closure methods for surgical site infection in laparoscopic appendectomy

• Published in: Asian journal of endoscopic surgery 2023-04, Vol.16 (2), p.181-188
• Main Authors: Fukuhara, Sotaro, Yano, Takuya, Yoshimitsu, Masanori, Oshita, Ko, Katsura, Yuki, Ishida, Michihiro, Satoh, Daisuke, Choda, Yasuhiro, Nakano, Kanyu, Shirakawa, Yasuhiro, Matsukawa, Hiroyoshi, Idani, Hitoshi, Shiozaki, Shigehiro, Okajima, Masazumi
• Format: Article
• Language: English
• Subjects: Appendectomy - methods; Appendicitis - surgery; Clinical outcomes; Endoloop; endostapler; Humans; Laparoscopy; Laparoscopy - methods; Postoperative Complications - epidemiology; Postoperative Complications - surgery; Retrospective Studies; surgical site infection; Surgical site infections; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology
• ISSN: 1758-5902; 1758-5910
• DOI: 10.1111/ases.13130

Introduction Although some studies have reported on the relationship between appendiceal stump closure methods and postoperative complications, there is no fixed method for this procedure. This study aimed to compare treatment outcomes of the existing procedures. Methods We retrospectively analyzed the records of 200 patients who underwent urgent laparoscopic surgeries and investigated whether the difference in the appendiceal stump closure method was a risk factor for surgical site infection. The patients were divided into the Endoloop and endostapler groups, and 45 propensity score‐matched patients were included. The treatment outcomes of the two groups were compared. Results The patients with high body temperature showed significantly developed surgical site infection in multivariate analysis (P = .036). There was no significant difference in the appendix stump methods (Endoloop vs endostapler). Regarding postoperative complications, superficial and deep incisional surgical site infection, organ/space surgical site infection, ileus, and complications of Clavien–Dindo grade IIIa or higher; there was no significant difference between the endoloop and endostapler groups after propensity score matching (P = .725, 1.000, .645 and .557, respectively). Conclusion By properly using the Endoloop and endostapler according to the severity of inflammation, the Endoloop can be safely performed in many cases. Inexpensive Endoloop as an option for stump closure methods should positively impact medical costs.