Techniques for Mesoappendix Division and Appendiceal Stump Closure: A Comparative Review

Abstract

Acute appendicitis is a leading cause of emergency abdominal surgery, with laparoscopic appendectomy (LA) established as the gold standard treatment. Notwithstanding its extensive utilization, there is no agreement on the most effective method for closing the appendiceal stump and dividing the mesoappendix. This review sought to assess existing treatments in terms of surgical duration, hospital length of stay (LOS), complications, and cost-effectiveness. A comprehensive review of 53 studies was performed. Eligible studies included adult patients undergoing appendectomy and examined various procedures for appendiceal stump closure and mesoappendix division. The primary outcomes were surgical duration and LOS; the secondary objectives were postoperative complications and cost-effectiveness. For appendiceal stump closure, clips and staples were frequently linked to decreased surgical duration in comparison to ligatures or sutures, although outcomes varied. Clips were also associated with a reduced length of hospital stay. Cost-effectiveness analyses consistently found clips to be the most economical option for stump closure, with staples the most expensive. Complication rates were largely comparable, though loop ligatures were linked to more organ/space infections, and clips showed higher rates of surgical site infections in some studies. For mesoappendix division, electrocautery and energy devices generally shortened operative time compared with mechanical methods. Electrocautery was the least costly for mesoappendix division, while energy devices tended to increase costs. Division of the mesoappendix and appendiceal stump closure can be achieved with a wide range of techniques and tools. The optimal treatment strategy varies significantly based on the outcome investigated.