Management of the difficult appendiceal stump: how I do it.

The appendix can usually be removed by the standard technique of stump ligation after transection, with or without inversion of the stump into the base of the cecum. When inflammation or necrosis extends into the cecum and the appendix cannot be ligated at its base, there are several options that can be employed. These include appendicocecostomy, partial cecal excision with a stapling instrument, and right colon resection. These techniques have been used 16 times in 249 patients operated upon for appendicitis. Although these techniques will be required infrequently, when they are necessary the risk of appendiceal stump breakdown with peritoneal soilage or cecal fistula can be minimized.