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High-volume center analysis and systematic review of stump appendicitis: solving the pending issue

Abstract

Purpose

Stump appendicitis (SA) is a rare long-term complication after laparoscopic appendectomy (LA) that can be associated with high morbidity due to delayed diagnosis. We aimed to determine the incidence, risk factors, diagnosis, and management of SA by reviewing our large cohort of LA and performing a systematic review of the literature.

Methods

We retrospectively reviewed data of all patients who developed SA after LA between 2006 and 2020. Demographics, peri-operative variables, and postoperative outcomes were analyzed. A systematic review of the PubMed/MEDLINE, Embase and GoogleScholar bibliographic databases was also performed to identify publications regarding SA following LA.

Results

A total of 2,019 patients underwent LA; 5 (0.25%) developed SA after a median of 292 days. The most common symptom at presentation was right lower quadrant pain. Four SA (80%) occurred in patients with a history of complicated appendicitis at index operation. All patients were diagnosed with computed tomography and underwent completion stump appendectomy by laparoscopy. No postoperative complications were recorded. A total of 55 studies with 76 cases of SA after LA were identified in the systematic review. Most SA (98.7%) underwent surgery: 52% by laparoscopic approach and 36% through an open approach. Stump appendectomy was performed in 94.4% cases and an extended resection in 5.6%.

Conclusion

Although SA is a rare complication after LA, a high index of clinical suspicious and imaging studies are key for early diagnosis and treatment. A laparoscopic resection of the inflamed appendiceal stump is feasible, safe, and highly effective. A minority of patients with severe cecum compromise may need extended resections or conversion to open surgery.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Code availability

Not applicable.

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Authors and Affiliations

Authors

Contributions

Conception and design: MAC, NHD and FS. Data acquisition: MAC, NHD and FS. Analysis and interpretation of data: MAC, NHD and FS. Drafting of the manuscript: MAC, NHD and FS. Critical revision of manuscript: MAC, NHD and FS.

Corresponding author

Correspondence to Francisco Schlottmann.

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Conflicts of interest

Maria A. Casas, Nicolás H. Dreifuss and Francisco Schlottmann has no conflict of interest or financial ties to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The institutional review board (IRB) approved this study. Written informed consent was waived by the IRB owing to the study’s retrospective nature.

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Casas, M.A., Dreifuss, N.H. & Schlottmann, F. High-volume center analysis and systematic review of stump appendicitis: solving the pending issue. Eur J Trauma Emerg Surg 48, 1663–1672 (2022). https://doi.org/10.1007/s00068-021-01707-y

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Keywords

  • Stump appendicitis
  • Acute appendicitis
  • Laparoscopy
  • Laparoscopic appendectomy