Necessity of Invaginating the Appendiceal Stump in Laparoscopic Appendectomy for Acute Nonperforated Appendicitis

Objective This study aimed to assess the necessity of invaginating the appendiceal stump in laparoscopic appendectomy for patients with acute nonperforated appendicitis. Summary of background data Laparoscopic appendectomy has become the preferred method over open appendectomy for acute appendicitis, offering benefits such as shorter intraoperative times and reduced wound sepsis. However, the necessity of invaginating the appendiceal stump, aimed at preventing stump leakage and intrabdominal infection, remains unclear. Methods This retrospective observational study was conducted at Nippon Medical School Musashikosugi Hospital from 2009 to 2018 and involved patients aged ≥15 years diagnosed with acute nonperforated appendicitis who underwent emergency surgery without preoperative intra-abdominal abscess. Patients were divided into 2 groups: open appendectomy with stump invagination (Group O) and laparoscopic appendectomy without stump invagination (Group L). The primary outcomes were incidences of appendiceal stump leakage and postoperative intra-abdominal abscess. Results The study involved 119 patients in Group O and 175 in Group L. Both groups were comparable in age, sex, body mass index, blood examination results, operating time, and drain insertion rate. Group L presented more cases of gangrenous appendicitis with severe inflammation but had shorter postoperative stays compared with Group O. The incidence of postoperative intra-abdominal abscess was 2% (2 cases) in Group O and 2% (4 cases) in Group L with no significant difference. No cases of stump leakage were observed in either group. Conclusions Invaginating the appendiceal stump in laparoscopic appendectomy for nonperforated appendicitis may be unnecessary as its omission does not increase short-term postoperative complications.