Technical modifications of appendiceal transection during laparoscopic appendectomy

Introduction: Appendiceal transection is the most critical part of laparoscopic appendectomy (LAPPE). The aim of our study was to evaluate postoperative and economic outcomes of laparoscopic appendectomy with different technical modifications of transection of the appendix. Methods: This was a prospective, randomized, unicenter clinical study comparing different techniques of appendiceal transection in patients with acute appendicitis during the study period (18 months). The patients were randomized to one of three arms – endoloop, hem-o-lok clips and the stapler. Results: In total, 120 patients were enrolled in the study. The shortest operative time was noted in the hem-o-lok arm (37.3 minutes); mean length of hospital stay (3.7 days) was comparable in all study arms. Postoperative morbidity was 6.6%; all recorded complications were SSIs (Surgical Site Infections). The number of postoperative complications was comparable in all study arms. Mean direct costs of laparoscopic appendectomy were lowest in the hem-o-lok arm. According to our findings, LAPPE is not a profit making surgery irrespective of the type of appendiceal transection (mean profit in the study patients was CZK -4019). Conclusion: The rate of postoperative complications was similar for all the technical modifications of appendiceal stump closure. As indicated by the study outcomes, hem-o-lok clips have the potential of becoming the method of choice in securing the appendix base during LAPPE.