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World J Surg Proced. Nov 28, 2013; 3(3): 47-53
Published online Nov 28, 2013. doi: 10.5412/wjsp.v3.i3.47
Back to basics: A meta-analysis of stump management during open appendicectomy for uncomplicated acute appendicitis
Gianpiero Gravante, Shuker Yahia, Roberto Sorge, George Mathew, Ashish Kelkar
Gianpiero Gravante, Ashish Kelkar, Department of Colorectal Surgery, Kettering General Hospital, NN16 8UZ Kettering, United Kingdom
Shuker Yahia, George Mathew, Department of Colorectal Surgery, George Eliot Hospital, CV10 7DJ Nuneaton, United Kingdom
Roberto Sorge, Department of Human Physiology, Laboratory of Biometry, University of Rome "Tor Vergata", 00173 Rome, Italy
Author contributions: Gravante G and Yahia S collected and analysed the data and wrote the article; Sorge R performed the statistical analysis on data, interpreted them and critically revised the article; Mathew G and Kelkar A contributed to conception and design of the article and critically revised it; all authors gave the approval to the final draft.
Correspondence to: Gianpiero Gravante, BSC, MBBS, PhD, Department of Colorectal Surgery, Kettering General Hospital, Rothwell Road 10, NN16 8UZ Kettering, United Kindom.
Telephone: +44-116-168244 Fax: +39-623-3216592
Received: July 28, 2013
Revised: September 2, 2013
Accepted: September 14, 2013
Published online: November 28, 2013

AIM: To compare simple ligation vs stump invagination during open appendicectomy for uncomplicated acute appendicitis on the risk of postoperative complications.

METHODS: A meta-analysis was conducted on randomised controlled trials comparing the two stump closure methods in open appendicectomy. Databases searched were PubMed, EMBASE and Cochrane Library databases. Included were those studies focusing on inflamed and suppurative appendicitis while perforated and gangrenous appendix was excluded. We also excluded retrospective case-control studies, commentaries, historical technical articles, or trials involving laparoscopic appendicectomies. The outcome of the meta-analysis was to find eventual differences in the incidence of postoperative ileus and wound infections between the two techniques of stump invagination.

RESULTS: Seven studies were included corresponding to 1468 patients. Postoperative complications consisted in wound infections (7%), ileus (4%), pyrexia (2%), vomiting (1%), obstructions from adhesions (0.1%). No cases of peritonitis, fecal fistulas (stump leaks), abdominal abscesses or wound dehiscences were reported. Postoperative ileus within the first 72 h was four times more frequent with stump invagination compared to simple ligation (OR: 4.06; 95%CI: 2.14-7.70; P < 0.0001). No significant differences were noted for wound infections (OR: 1.24; 95%CI: 0.83-1.87; P = 0.30) while for the remaining complications the incidence was extremely low in both groups. There was a high homogeneity on results (Q value for heterogeneity of postoperative ileus P = 0.17; Q value for heterogeneity of wound infections P = 0.98).

CONCLUSION: Stump invagination does not seem to prevent infective complications but is associated with an increased risk of postoperative ileus in uncomplicated cases. Appropriate studies on complicated appendicitis should now evaluate the influence of the two techniques in this higher-risk subgroup.

Keywords: Appendiceal stump, Open appendicectomy, Invagination, Appendicitis, Complications

Core tip: Despite the increased use of the laparoscopic approach, open appendicectomy is an operation still performed on a large scale worldwide. Two main approaches exist for the stump closure, the simple ligation and the stump invagination. Compared to the simple ligation the invagination of the stump aim to provide an extra safety measure for the prevention of postoperative complications, but the study demonstrated that in cases of non-complicated appendicitis it increases the risks of postoperative ileus and does not decrease the wound infections rate.