[Importance of appendix stump management in laparoscopic appendectomy].

In laparoscopic appendectomy several variants of technique have been proposed. In a randomized prospective trial we compared three common techniques: 1. application of two endoloops, 2. application of two endoloops and additional manual stump sinking 3. application of endo-cutter. The study included 150 patients, 50 each per technique. The application of two endoloops with additional manual stump sinking as well as the cutter technique were associated with a low risk for complications. In contrast, appendectomy by two endoloops without stump sinking was associated with a higher risk for local complications. The manual stump sinking requires a high level of manual experience, whereas the cutter technique can be learned rapidly by surgical residents. Therefore, we recommend the cutter technique as standard procedure, because it allows laparoscopic appendectomy to be performed with high reliability by experienced surgeons as well as by novice surgical residents.