Laparoscopic endostapler partial cecal resection in complicated appendicitis with appendiceal base involvement: a single-center retrospective study

BACKGROUND: Acute appendicitis (AA) is a common cause of acute abdomen. Appendiceal base gangrene or perforation represents a severe form of complicated appendicitis, in which secure closure of the appendiceal stump is crucial for surgical management, and no standardized optimal strategy has yet been established. OBJECTIVE: This study aimed to evaluate the safety and feasibility of laparoscopic endostapler partial cecal resection in patients with complicated appendicitis involving appendiceal base gangrene or perforation. METHODS: A retrospective study was conducted on consecutive patients who underwent surgical treatment for appendicitis at our center between January 2021 and January 2025. Patients classified as Gomes grade 3B (appendiceal base gangrene or perforation) were identified based on intraoperative findings. Baseline characteristics and perioperative outcomes were collected. Exploratory analyses across appendicitis subtypes were performed to provide contextual information. A single-arm descriptive analysis was conducted in the Gomes grade 3B cohort. The primary outcomes were postoperative complications and readmission assessed over a 3-month follow-up period. RESULTS: A total of 785 patients were included in the analysis, including 484 with uncomplicated appendicitis and 301 with complicated appendicitis, of whom 277 did not involve the appendiceal base and 24 were classified as Gomes grade 3B. In the Gomes grade 3B cohort, all patients successfully underwent laparoscopic surgery without conversion to open surgery or intraoperative complications. The mean operative time was 123.33 ± 16.59 min. The median time to oral intake was 3.0 days (2.5-3.0), and the median length of hospital stay was 5.0 days (5.0-5.0). Postoperative complications occurred in three patients (12.50%), all classified as Clavien-Dindo grade I-II. No severe complications (Clavien-Dindo grade III-V) or readmissions were observed during the 3-month follow-up period. CONCLUSIONS: Laparoscopic endostapler partial cecal resection showed technical feasibility and acceptable short-term safety in patients with complicated appendicitis with appendiceal base involvement. This technique may represent a potential surgical option for this specific patient population, although further studies are required.