Short Stitch Technique Appendectomy
Direct Answer
The "short stitch" or simple ligation technique should be used for appendiceal stump closure rather than stump inversion, as it provides equivalent safety with shorter operative times, less postoperative ileus, and faster recovery. 1
Stump Closure Technique Recommendation
Simple ligation is strongly preferred over stump inversion for both open and laparoscopic appendectomy. 1 The evidence supporting this is robust:
- Simple ligation demonstrates similar major morbidity and infectious complication rates compared to stump inversion, but with significantly better operative efficiency. 1
- Patients experience shorter operative times, reduced postoperative ileus, and quicker overall recovery with simple ligation. 1
- This recommendation carries high quality evidence (QoE: High) with strong strength of recommendation (1A). 1
Specific Methods for Stump Closure
For the actual closure device, the following hierarchy applies:
- Endoloops/suture ligation or polymeric clips are recommended for stump closure in both uncomplicated and complicated appendicitis. 1, 2
- Polymeric clips are the most cost-effective method with the shortest operative times, particularly for uncomplicated appendicitis. 2
- Endostaplers may be reserved for complicated cases based on intraoperative surgeon judgment and resource availability, but offer no clinical benefit over endoloops in routine cases. 1, 2
- This recommendation has moderate quality evidence with strong strength (1B). 1
Surgical Approach Context
The short stitch/simple ligation technique should be implemented within the broader context of optimal appendectomy technique:
- Laparoscopic appendectomy is the preferred surgical approach for acute appendicitis in both adults and children when equipment and expertise are available. 2, 3, 4
- Laparoscopic approach provides less postoperative pain, lower wound infection rates, shorter hospital stays, faster return to work, and improved quality of life compared to open surgery. 2, 3, 5
- For complicated appendicitis, laparoscopic appendectomy demonstrates significantly shorter operative time (55 vs 70 minutes), lower wound infection rates (0.6% vs 10%), and reduced hospital stay compared to open approach. 5
Critical Pitfalls to Avoid
- Do not use stump inversion techniques, as they unnecessarily prolong operative time without improving outcomes. 1
- Do not use endostaplers routinely for uncomplicated appendicitis, as they increase costs without clinical benefit over simpler methods. 2
- Avoid placing abdominal drains after appendectomy for complicated appendicitis in adults, as drains provide no benefit in preventing intra-abdominal abscess and lead to longer hospitalization. 1, 3
Additional Intraoperative Considerations
- Use monopolar electrocautery or bipolar energy for mesoappendix dissection due to cost-effectiveness. 2, 3
- For complicated appendicitis with intra-abdominal collections, use suction alone without peritoneal irrigation during laparoscopic appendectomy. 2, 3
- Verify complete appendiceal removal and adequate stump closure to prevent stump appendicitis. 6