EGS SO14 - Tip First vs. Base First approaches in appendicectomies

Abstract Background Appendicectomies are common. Techniques can be classified into tip-first (stripping the appendix off the mesoappendix) or base-first (ligating the base of mesoappendix), where the latter includes the entire mesoappendix in specimens. This study examines these two techniques and compare their pathological and clinical outcomes, noting that tip-first technique leaves mesoappendices behind. Method This retrospective study classifies the two techniques of appendicectomies according to histological analyses where the tip-first approach produced no mosoappendix in the specimen. We investigated:Baseline characteristics: Age, gender, ASA-grades, emergenciesOperative differences: Surgeon grades, operating duration, laparoscopic ratesThe pathological outcomes: specimen length, presence of malignanciesClinical outcomes: Post-op stay, further treatments Results Over 12-months, 134 consecutive appendicectomies were identified (94 base-first and 40 tip-first), without significant baseline differences, although the base-first group were notably older (p=0.051). Laparoscopic rates and operating times were comparable. There were significantly higher number of consultant-led operations in the base-first group: 41.5% vs 22.5% (P=0.036). The appendix specimen is insignificantly longer in the base-first group (P=0.477). Five incidental malignancies were found, of which 2(5%) were in the tip-first group. Without the mesoappendix, completeness of excision was indeterminate and subsequent right hemicolectomies were performed. Lengths of stays were not significantly different. Conclusion We found preference of tip-first appendicectomies among junior surgeons while consultants favour base-first approaches, which may be attributable to experiences and trainings. Two tip-first appendicectomies resulted in incomplete staging of incidental malignancies which necessitated further surgical resections. We conclude base-first appendicectomies should be taught to all trainee surgeons.