Is Invagination of Appendicular Stump in Appendicectomy Necessary? A Prospective Randomized Clinical Study

Background: Invagination of appendicular stump during appendicectomy has traditionally been practiced by many surgeons despite lack of evidence to justify its benefit. This prospective randomized clinical study was conducted to evaluate, in our setting, the necessity of appendicular stump invagination during appendicectomy. Methods: A prospective randomized clinical study was conducted at Bugando Medical Centre between April 2009 and March 2010 to evaluate the necessity of appendicular stump invagination during appendicectomy. Patients were randomized into two groups i.e. Group I (simple ligation without stump invagination) and Group II (ligation with stump invagination). Results: A total of 87 patients were studied and randomized into two groups, one group of patients had the appendicular stump treated by ligation alone (n= 43) and the other group underwent ligation and invagination (n= 44). The two groups were similar with respect to age, sex, duration of illness, degree of appendiceal inflammation, anatomical location of appendix and antibiotic treatment. There was no statistically significant differences in the rate of postoperative complications and postoperative hospital stay between the two groups (P >0.05). The mean operating time was significantly shorter in the group without invagination (P =.0.002). The rate of postoperative paralytic ileus was more in Group-II, 9.3% and 2.3% during first 48 hours and 72 hours respectively as compared to Group-I, which is significantly higher in group-II (P < 0.05). Conclusion: We conclude that simple ligation of the appendicular stump during appendicectomy is safe, simple and shortens operating time. Simple ligation is therefore recommended as standard procedure in appendicectomy.