title: Appendix stump closure with endoloop in laparoscopic appendectomy.
abstract: OBJECTIVE
  To address the question of the appendix stump closure in laparoscopic appendectomy and evaluate the incidence of intraoperative and postoperative complications after application of endoloops.
  
  
  METHODS
  Data included age and gender, ASA score, co-morbid illness, prior abdominal surgery, clinical presentation, operative time, conversion rate and reasons for conversion, postoperative morbidity and mortality rates, pathologic diagnosis, and length of hospital stay.
  
  
  RESULTS
  Laparoscopic appendectomy with stump closure using endoloops was performed in 35 consecutive patients. Postoperative complications occurred in three patients. The mean postoperative hospital stay was 2 days. The perioperative mortality rate was 0%.
  
  
  CONCLUSIONS
  The treatment of appendiceal stump closure in laparoscopic appendectomy represents the main technical aspect and it is an important step for its potentially serious postoperative complications due from an inappropriate management. Endostapling, hem-o-lok clips and intracorporeal knotting are the most commonly recommended methods. All alternatives have advantages and disadvantages against the different clinical stages of acute appendicitis, and it should be noted that the different forms of appendiceal stump closure have never been assessed in prospective randomized studies.
  
  
  CONCLUSIONS
  From our experience we can confirm that the endoloop can be safely used and should be the preferred modality in treating the appendiceal stump, especially for low-grade appendicitis. Alternative methods should be used in case of phlegmonous or gangrenous appendicitis, perityphlitic abscess or simultaneous operation for Meckel's diverticulum. Knowledge about and appropriate use of all of them are important for a safe and more cost-effective procedure.
  
  
  BACKGROUND
  Appendiceal stump closure, Laparoscopic appendectomy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Caglià
authors.forename: Angelo
authors.initials: A
authors.lastname: Tracia
authors.forename: Daniele
authors.initials: D
authors.lastname: Spataro
authors.forename: Laura
authors.initials: L
authors.lastname: Borzì
authors.forename: Bibiana
authors.initials: B
authors.lastname: Lucifora
authors.forename: Luciano
authors.initials: L
authors.lastname: Tracia
authors.forename: Corrado
authors.initials: C
authors.lastname: Amodeo
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000295:instrumentation; D001062:Appendectomy / Q000295:instrumentation / Q000379:methods; D001064:Appendicitis / Q000601:surgery*; D061887:Conversion to Open Surgery; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008026:Ligation / Q000295:instrumentation; D061646:Operative Time; D012307:Risk Factors; D013536:Suture Techniques / Q000009:adverse effects / Q000191:economics; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000295:instrumentation*