Management of the stump in complicated acute appendicitis: Conversion to open surgery or laparoscopic stapler?

INTRODUCTION: This study aims to compare the efficacy and safety of using laparoscopic staplers versus conversion to open surgery in the management of the appendiceal stump in cases of complicated acute appendicitis (AA).
METHODS: A total of 123 patients who underwent surgery for complicated AA at our clinic between 2020 and 2024 were included in the study. Of these, 98 (79.7%) underwent open appendectomy (OA), and 25 (20.3%) underwent laparoscopic appendectomy (LA) with a stapler. The patients were retrospectively analyzed and compared in terms of demographic characteristics, hospital stay duration, post-operative complications, and surgical site infections.
RESULTS: The mean age of the patients was 37.60±11.23 years, and the mean BMI was 28.77±3.90kg/m². The mean hospital stay was 5.02±1.77 days. Surgical site infections were more frequent in the OA group (27.6%) compared to the LA group (8.0%) (p=0.040). The mean hospital stay was longer in the OA group (5.16±1.79 days) compared to the LA group (4.44±1.58 days) (p=0.049). No significant difference was found in the incidence of post-operative complications between the two groups (p=0.526).
DISCUSSION AND CONCLUSION: The findings suggest that completing the surgery laparoscopically results in better outcomes compared to converting to open surgery in cases of complicated acute appendicitis. The use of a laparoscopic stapler is associated with safer and more effective closure of the appendiceal stump, leading to fewer surgical site infections and shorter hospital stays. Prospective studies with larger patient populations are needed to confirm these findings.