Comparison of three different methods for stump closure in laparoscopic appendectomy: Endoloop, Hem-o-lok clip, and endostapler.

Background: Acute appendicitis is a common surgical emergency that causes acute abdominal pain and affects approximately 7-8% of the population during their lifetime. The closure of the appendix stump during laparoscopic appendectomy is one of the most critical steps of the surgery to prevent life-threatening complications such as postoperative fistula, peritonitis, and sepsis. The mate-rial chosen for appendix stump closure must be effective, safe, and economical. However, there is still no consensus on the optimal method for stump closure. In this study, we aimed to compare the advantages and reliability of three different methods used for appendix stump closure.

Methods: At Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of General Surgery, cases that underwent laparoscopic appendectomy for acute appendicitis between January 2022 and April 2024 were retrospectively analyzed using the hospital's data system. The patients' demographic data, laboratory values, pathology reports, surgical notes, duration of hospital stay, duration of surgery, total hospital costs, complications related to the surgery within 30 days postoperatively, and the management of these complications were examined.

Results: The study included a total of 150 individuals, with 83 (55.33%) males and 67 (44.67%) females. The average age of the participants was 38.45±14.48 years. In terms of the materials used for stump closure, endoloop was used in 82 (54.67%) cases, Hem-o-lok clip in 30 (20.00%) cases, and endostapler in 38 (25.33%) cases. In 144 (96%) cases, no Clavien-Dindo (CD) complications were observed, while complications occurred in six (4%) cases. These six complications included two intra-abdominal abscesses (CD Grade 3), two wound infections (CD Grade 1), one case of bleeding (CD Grade 2), and one pulmonary embolism (CD Grade 4).

Conclusion: The use of endoloop, polymeric clips, and endostapler in laparoscopic appendectomy is safe and effective for appendectomy. All three methods can be successfully applied without an increase in intraoperative or postoperative complications. However, due to the higher treatment costs associated with endostapler, its use should be reserved for situations where securing the appendix stump cannot be achieved with endoloop or Hem-o-lok clip.