Transcolonic Endoscopic Appendectomy: A Single-Step "Two-In-One" Approach for Recurrent Appendicitis With Appendiceal Orifice Lesions.

Abstract

Objectives: Appendiceal orifice lesions are occasionally detected during colonoscopy in patients with recurrent appendicitis. Conventional surgery with partial cecal resection may cause unnecessary trauma. Transcolonic endoscopic appendectomy (TEA) has been proposed as a minimally invasive alternative. We aimed to evaluate the feasibility, safety, and efficacy of transcolonic endoscopic appendectomy and to compare through-the-scope twin clips (TTS-TC) combined with metal clips versus metal clips alone for defect closure.

Methods: Twenty patients with recurrent appendicitis and no prior abdominal surgery who underwent transcolonic endoscopic appendectomy between December 2020 and December 2024 were included. Clinical and pathological variables, procedural parameters, and follow-up outcomes were analyzed. TTS-TC plus metal clips and metal clips alone for defect closure were compared.

Results: All procedures were technically and clinically successful. Postoperative time to resume diet and length of hospital stay were 4.05 and 6.40 days, respectively. TTS-TC combined with metal clips reduced suture time (18 min [interquartile range {IQR} 15.5-20 min] vs. 25 min [IQR 20-30 min]), procedure time (85 min [IQR 72.5-92 min] vs. 115 min [IQR 110-124 min]), and number of clips used (7 [IQR 6.5-8] vs. 8 [IQR 7-9]) compared with metal clips alone. No adverse events were reported. Colonoscopy performed at 3 months post-procedure showed no residual lesions or recurrence.

Conclusions: TEA is a feasible, safe, and effective approach for recurrent appendicitis with orifice lesions. It provides a minimally invasive dual-benefit strategy and can be facilitated by a novel closure method to streamline the procedure.