Surgical Appendiceal Stump Closure - a Comparison Between Surgical Appendiceal Base Closure Methods, and Appendiceal Stump Complications.

Study Overview
=================
Brief Summary
-----------------
comparing the rate and severity of postoperative complication after LA in regards of different appendiceal stump closure techniques. Data regarding different operative and postoperative parameters was collected from all appendectomies performed in a single medical center in Israel during the years 2010-2020.

Detailed Description
-----------------
To date, laparoscopic appendectomy (LA) is still the most common surgical procedure done in an acute setting [1,2]. Most patients presenting to the ER with acute appendicitis, will undergo an appendectomy in the same hospital admission [3]. The widely practiced technique for LA, is the placement of access trocars in a proper triangulation, insufflation of the abdomen to create a pneumoperitoneum, dissecting through the mesoappendix with electrothermal devices to expose the appendiceal base, appendiceal stump closure and appendiceal resection, and finally extraction of the resected appendix [4]. There are multiple techniques to close and secure the appendiceal stump. The use of staples, clips and prepared surgical knots such as the ENDOLOOP with PDS suture is widely in use. Although requiring less manual surgical skill to use, the costs of staples and clips are higher than the prepared suture, and the use of larger trocars is obligatory [4]. Yet, data comparing the postoperative efficacy and safety of these appendiceal stump closure techniques is scarce. The aim of this study is to compare the postoperative efficacy and safety of appendiceal stump closure techniques, and to assess their cost effectiveness. This is a retrospective, single center study, comparing the rate and severity of postoperative complication after LA. Data regarding different operative and postoperative parameters was collected from all appendectomies performed in a single medical center in Israel during the years 2010-2020.

Official Title
-----------------
Surgical Appendiceal Stump Closure - a Comparison Between Surgical Appendiceal Base Closure Methods, and Appendiceal Stump Complications.

Conditions
-----------------
All Appendectomies Performed During the Designated Period in Single Medical Center

Intervention / Treatment
-----------------
* Procedure: laparoscopic appendectomy using a single endoloop for appendiceal stump closure
* Procedure: laparoscopic appendectomy using two endoloops for appendiceal stump closure
* Procedure: laparoscopic appendectomy using a clip for appendiceal stump closure


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: all patients over the age of 18, who underwent appendectomy between the years 2010-2020 Exclusion Criteria: patients who did not undergo appendectomy patients who underwent appendectomy not using one of the accepted techniques do appendiceal stump closure

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 120 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Appendectomy performed with single endoloop to appendiceal stump<br>Appendectomy performed with single endoloop for closure of appendiceal stump | Procedure: laparoscopic appendectomy using a single endoloop for appendiceal stump closure<br>* laparoscopic appendectomy using a single endoloop for appendiceal stump closure before resecting the appendix<br>|
| Appendectomy performed with two endoloops to appendiceal stump<br>Appendectomy performed with two endoloops for closure of appendiceal stump | Procedure: laparoscopic appendectomy using two endoloops for appendiceal stump closure<br>* laparoscopic appendectomy using a two endoloops for appendiceal stump closure before resecting the appendix<br>|
| Appendectomy performed with a clip to appendiceal stump<br>Appendectomy performed with a clip for closure of appendiceal stump | Procedure: laparoscopic appendectomy using a clip for appendiceal stump closure<br>* laparoscopic appendectomy using an endoclip for appendiceal stump closure before resecting the appendix<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative complications | postoperative complications such as abscess formation, perforation, need of second surgery. complications measured with clavien-dindo classification | 30 days | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
endoloop, laparoscopic appendectomy, appendiceal stump