Transumbilical laparoscopic-assisted appendectomy for acute appendicitis in children: appendiceal stump inversion is not necessary-a retrospective study

Purpose: Acute appendicitis is one of the most common surgical conditions in pediatric and general surgery. The purpose of this study was to retrospectively investigate the management strategies of the appendiceal stump during transumbilical laparoscopic-assisted appendectomy for acute appendicitis in terms of surgical time, hospital length of stay, and postoperative complications. Methods: The records of patients < 18 years of age who were treated for acute appendicitis at our Pediatric Surgery Unit from December 2018 to January 2024 were retrospectively reviewed. Data were extrapolated from the departmental database, and clinical notes were reviewed. Results: The records of 278 patients who underwent appendectomy within a 5-year period at our institution were essentially used to compare appendiceal stump inversion and simple ligation. Appendiceal stump invagination was performed in 208 patients (74.8%), comprising 106 females (51.0%) and 102 males (49.0%), with a median age of 11 years (IQR 8–15) and a median weight of 36.5 kg (IQR 28–54). Twenty-six (12.5%) patients had associated conditions. The appendiceal stump was not invaginated in 70 children (25.2%), consisting of 26 females (37.1%) and 44 males (62.9%), with a median age of 11 years (IQR 8–14) and a median weight of 38.3 kg (IQR 29.5–47). Fourteen patients (20%) had associated pathologies. The two groups were similar in terms of sex (P = 0.05), age (P = 0.40), weight (P = 0.78), and associated pathologies (P = 0.12). Notably, 78.6% of appendicitis cases treated without stump invagination were uncomplicated, whereas 20% were complicated (4.3% abscess and 15.7% peritonitis cases). In contrast, stump invagination was performed in 87% of uncomplicated appendicitis and 13.1% of complicated appendicitis cases (6.8% abscess and 6.3% peritonitis cases). Therefore, simple ligation was also effective in complicated appendicitis cases (P = 0.03). In addition, the median surgical duration was 63.5 min (IQR 46–90) for patients undergoing stump inversion and 69 min (IQR 60–115) for patients undergoing simple ligation respectively (P = 0.02). Interestingly, statistical analysis revealed no significant differences in length of hospital stay (P = 0.21) and postoperative complications (P = 0.15). Conclusion: Simple ligation does not compromise treatment efficacy nor increase postoperative complications, nor the length of hospital stay.