Transumbilical Laparoscopic-assisted Appendectomy (Tulaa) for Acute Appendicitis in Children: to Bury or Not to Bury the Appendiceal Stump? – a Retrospective Cohort Study

Introduction: Acute appendicitis is one of the most common surgical conditions in pediatric and general surgery. To date, the management of the appendiceal stump during appendectomy remains controversial. The purpose of this study was to retrospectively investigate the management strategies of acute appendicitis in a tertiary children’s hospital in terms of surgical techniques and time, hospital length of stay, and postoperative complications. Methods: The records of patients < 18 years of age who were treated for acute appendicitis at our Pediatric Surgery Unit from December 2018 to January 2024 were retrospectively reviewed. Data were extrapolated from the departmental database, and clinical notes were reviewed. Results: The records of 278 patients who underwent appendectomy within a 5-year period at our institution were essentially used to compare appendiceal stump inversion and simple ligation. The two groups were similar in terms of sex (P = 0.05), age (P = 0.40), weight (P = 0.78), and associated pathologies (P = 0.12). Statistical analysis revealed no significant differences in length of hospital stay (P = 0.21) and postoperative complications (P = 0.15). Notably, 78.6% of appendicitis cases treated without stump invagination were uncomplicated, whereas 20% were complicated (4.3% abscess and 15.7% peritonitis cases). In contrast, AS invagination was performed in 87% of uncomplicated appendicitis and 13.1% of complicated appendicitis cases (6.8% abscess and 6.3% peritonitis cases). Therefore, simple ligation was also effective in complicated appendicitis cases (P=0.03), with no significant difference in postoperative complications (P = 0.15). Conclusions: Simple ligation does not compromise treatment efficacy nor increase postoperative complications, nor the length of hospital stay. Specifically, our data suggest that simple ligation is at least as effective as invaginating the appendiceal stump, and it might probably simplify the whole procedure.