Technical Modifications of Appendicular Stump Closure During Laparoscopic Appendectomy
Technical Modifications of Appendicular Stump Closure During Laparoscopic Appendectomy
Laparoscopic appendectomy (L-APPE) presents a golden standard in the treatment of acute
 appendicitis nowadays. However, there are ongoing controversies regarding the ideal technique
 of appendicular stump closure during L-APPE in the published literature. Several technical
 modifications of appendicular stump closure are available at the present - closure using
 endoloop, endostapler or Hem-o-lock clips. The aim of the proposed project (CAS study) is to
 compare medical and economic outcomes of patients undergoing L-APPE with different methods of
 appendicular stump closure (endostapler, endoloop and Hem-o-lock clips).
Acute appendicitis presents one of the most common surgical illnesses which affect
 approximately 7% of the western population. In the Czech Republic, 11664 patients were
 hospitalized and operated for the diagnosis of acute appendicitis (K35-K38) during 2016. It
 might seem that the procedure of appendectomy will be guided by a clear algorithm for its
 frequency, but it is not so. Because of acute appendicitis, appendectomy may be performed via
 laparotomy or laparoscopy (minimally invasive surgery). During laparoscopic appendectomy
 (L-APPE), there are no clear recommendations regarding trocar placement, methods of dividing
 appendicular mesenteriolum, methods of appendicular stump closure or appendicular stump
 sinking.

 The proposed clinical study is focused on the issue of the appendicular base interruption
 during L-APPE. At the present, there are several technical modifications of appendicular
 stump closure - by means of endoloop (the suture loop from absorbable fiber), endostapler or
 using Hem-o-lock clips. The performed literature search revealed that evidence-based medicine
 data regarding the optimal way of appendicular stump closure are insufficient. That is why
 the investigators have decided to conduct a prospective randomized single-center clinical
 study aimed to compare different technical modifications of appendicular stump closure during
 L-APPE. Within a study period, all patients undergoing L-APPE at the University Hospital
 Ostrava will be randomized to one of the technical modifications of appendicular stump
 closure.

 The aim of the project (CAS study) is to compare medical and economic outcomes of patients
 undergoing L-APPE with different methods of appendicular stump closure (endostapler, endoloop
 and Hem-o-lock clips). The operative time, intraoperative and postoperative complications
 will be the primary outcome measures of the study, economic outcomes will be the secondary
 outcome measures.
Inclusion Criteria:

 -  age ≥18 years

 -  acute appendicitis

 -  laparoscopic approach

 -  signed informed content

 Exclusion Criteria:

 - necrosis or advanced inflammatory changes in the area of appendicular stump