Stump Closure Techniques in Laparoscopic Appendectomy: Analysis of 511 Patients

Stump Closure Techniques in Laparoscopic Appendectomy




Laparoscopy,, Appendectomy,, Stump


AIM : Laparoscopic appendectomy has become an accepted method for the management of acute appendicitis. Closing the appendiceal stump is a crucial step in this operation. Although various methods for stump closure have been described, there is no evidence-based consensus in the literature. In our study, we aimed to compare the stump closure techniques used in laparoscopic appendectomy surgeries performed in our clinic.


METHODS: Laparoscopic appendectomy operations conducted between 2017 and 2021 were retrospectively examined. Demographic information, operation durations, length of hospital stays, Alvarado scores, intraoperative findings, readmissions, reoperations, intra-abdominal abscesses, wound site infections, stump leakage, ileus, and other complications were evaluated for a total of 511 patients.


RESULTS: Of the patients, 193 (37.8%) were female, and 318 (62.2%) were male. The mean age was 37.84 years, with an Alvarado score of 6.89, and an average hospital stay of 1.45 days. Stump closure methods were as follows: 208 (40.7%) patients with Hem-o-lok polymer clips (HLK), 59 (11.5%) patients with endo-stapler (EDS), 111 (21.7%) patients with manually inserted loops (EYL), and 133 (26%) patients with endoloop (EDL). According to the method, the average operation durations were determined as 48.28 minutes in the HLK group, 51.69 minutes in the EDS group, 48.23 minutes in the EYL group, and 48.80 minutes in the EDL group. Hospital stays were observed to be the longest in the EDS group with an average of 1.73 days based on the stump closure method. Complications developed in 2 patients in the HLK group, 2 patients in the EDS group, and 1 patient in both the EYL and EDL groups.


CONCLUSION: The examined stump closure methods appeared to be similar in terms of application and complications. Although the study included a large series of patients, these findings need to be confirmed through prospective randomized controlled trials



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Semm K. Endoscopic appendectomy. Endoscopy 1983;15(2):59–64.

Li X, Zhang J, Sang L, et al. Laparoscopic versus conventional appendectomy--a meta-analysis of randomized controlled trials. BMC Gastroenterol 2010 ( 3);10:129.

Athanasiou C, Lockwood S, Markides GA. Systematic Review and Meta-Analysis of Laparoscopic Versus Open Appendicectomy in Adults with Complicated Appendicitis: an Update of the Literature. World J Surg. 2017;41(12):3083–3099.

Yu MC, Feng YJ, Wang W, et al. Is laparoscopic appendectomy feasible for complicated appendicitis ? A systematic review and meta-analysis. Int J Surg 2017 ;40:187–197.

Ureyen O, Tan S, Dadalı E, et al. Hem-o-lok clips versus intracorporeal knotting for the closure of the appendix stump in laparoscopic appendectomy: A prospective randomized study. Ulus Travma Acil Cerrahi Derg 2020 ;26(3):384–388.

Swank HA, van Rossem CC, van Geloven A ,et al. Endostapler or endoloops for securing the appendiceal stump in laparoscopic appendectomy: a retrospective cohort study. Surg Endosc 2014;28(2):576–583.

Beldi G, Vorburger SA, Bruegger LE, et al .Analysis of stapling versus endoloops in appendiceal stump closure. Br J Surg 2006;93(11):1390–1393.

Mayir B, Bilecik T, Ensari CO, et al .Laparoscopic appendectomy with hand-made loop. Wideochir Inne Tech Maloinwazyjne 2014; 9(2):152–156.

Marcinkeviciute K, Luksaite-Lukste R, Jasiunas E, et al. Self-Locking Polymeric Clips Are Safe for the Closure of Appendiceal Stump in Laparoscopic Appendectomy. Medicina (Kaunas) 2023 9;59(3):533.

Hue CS, Kim JS, Kim KH, et al. The usefulness and safety of Hem-o-lok clips for the closure of appendicular stump during laparoscopic appendectomy. J Korean Surg Soc 2013; 84(1): 27–32.

Jaschinski T, Mosch CG, Eikermann M, et al. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2018 ( 28);11(11):CD001546

Mannu GS, Sudul MK, Bettencourt‐Silva JH, et al.Closure methods of the appendix stump for complications during laparoscopic appendectomy. Cochrane Database Syst Rev. 2017 Nov 13;2017(11):CD006437.

Makaram N, Knight SR, Ibrahim A, Patil P, Wilson MSJ. Closure of the appendiceal stump in laparoscopic appendectomy: A systematic review of the literature. Ann Med Surg (Lond). 2020; 57:228–235.

Zorzetti N, Lauro A, Bellini MI, Vaccari S, Dalla Via B, Cervellera M, Cirocchi R, Sorrenti S, D’Andrea V, Tonini V. Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis. World J Gastrointest Surg. 2022;14(9):1060–1071.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007;370(9596):1453–1457.

Gomes CA, Junior CS, de Peixoto RO, et al. Appendiceal stump closure by metal endoclip in the management of complicated acute appendicitis. World J Emerg Surg. 2013 1;8(1):35. doi: 10.1186/1749-7922-8-35

Sahm M, Kube R, Schmidt S, et al Current analysis of endoloops in appendiceal stump closure. Surg Endosc 2011;25(1):124-129. doi:10.1007/s00464-010-1144-5

Atak T. The use of the extracorporeally prepared hand-made endo-loop technique in laparoscopic appendectomy. Ulus Travma Acil Cerrahi Derg 2023 ;29(5):613-617. doi: 10.14744/tjtes.2023.86650.




How to Cite

Balas, Şener, Başpınar, A. ., Chousein , .Bourak, Sancak , A. F. ., Demir, S., & Karabacak, H. (2023). Stump Closure Techniques in Laparoscopic Appendectomy: Analysis of 511 Patients: Stump Closure Techniques in Laparoscopic Appendectomy. Chronicles of Precision Medical Researchers, 4(3), 410–413.