Open appendicectomy stump: invaginate or not to invaginate?

Mukesh S. Suvera, Ashish H. Kharadi, Unnati S. Asari, Panchshila B. Damor, Mihir T. Shah, Mansukh B. Patel


Acute appendicitis remains the most common abdominal surgical emergency. Appendicectomy is the standard treatment of acute appendicitis, which performed by open or laparoscopic approach. During open method, after removal of appendix, stump simple ligation or simple ligation and invagination. A prospective randomized study conducted at Smt SCL General Hospital, Smt NHL municipal Medical College, Ahmedabad between October 2009 to September 2011 to evaluate the necessity of appendicular stump invagination during appendicectomy. A total 110 patients were studied and randomized into two group, Group I stump simple ligation, transfixation and invagination and Group II stump simple ligation and transfixation only. There was no statically significant difference in the rate of postoperative complication and post operative hospital stay between the two groups. The mean operating time was significantly shorter in group without invagination. The rate of postoperative paralytic ileus was more in group I. We conclude that simple ligation of the appendicular stump during appendicectomy is safe, simple and shortens operating time.


Appendicitis, Ligation, Invagination, Alvarado (MANTRELS) score, Transfixation

Full Text:



Ellis BW. Acute appendicitis in Brian W Ellis and Simon Paterson-Brown, Hamilton Bailey’s Emergency Surgery 13th edition, Hodder Arnold: 399-410.

Boswell CB, Doherty GM. Dieseses of appendix. In Doherty GM, Meko JB, Olson JA, Peplinski GR, Worrall NK eds. The Washington Manual of Surgery 2nd edition Lippincott Williams and Wilkins 1999 Philadelphia: 228-35.

Sabiston Textbook of Surgery 18th edition, The Biological Basis Of Modern Surgical Practice, Section X Abdomen , Chapter 49 The appendix.

Addis DG, Shaffer N, Fowler BS, Tauxe RV: The epidemiology of appendicitis and appendicectomy in United States. Am J Epid 1990; 132: 910-925.

Korner H, Sordenaa K, Soreide JA et al. Incidence of acute non-perforated and perforated appendicitis: age specific and sex-specific analysis. World Surg 1997; 21: 313-317.

Schwartz principle of surgery, 8th edition, F Charles Brunicardi 29:The Appendix.

Scott-Conner C et al: Laparoscopic appendicectomy . Ann Surg 1992; 215: 660.

Mastery of Surgery 5th edition, Josef E. Fischer, M.D. , Kirby I. Bland, M.D. , Wolters Kluwer/ Lippincott Williams and Wilkins, Chapter 129: Appendicitis and Appendiceal Abscess.

Bailey and Love’s Short practice of surgery, 25th edition, Norman S. Williams, Christopher J. K. Bulstrode and P. Roman O’connell 67: The Vermiform Appendix 1204-1218.

Engstrom L, Fenyo G. Appendicectomy: assessment of stump invagination versus simple ligation: a prospective randomized trial. Br J Surg 1985; 72(12): 971-2.

Chaudhary IA, Samiullah, Mallhi AA, Afridi Z, Bano A. Is it necessary to invaginate the stump after appendicectomy? Pak J med Sci J 2005; 21(1) : 58-60.

Jacobs PP, Koeyers GF, Buryninckx CM. Simple ligation superior to inversion of the appendicular stump; a prospective randomized study. Ned Tijdschr Geneeskd. 1992; 136(21): 1020-3.

Mahzar R, Leem AM, Sarfraz A, Riaz U. Appendicectiomy; non-invagination vs. invagination of appendicular stump. Ann King Edward Med Coll 2006; 12(1): 58-60.

Lavonius MI, Liesjarvi S, Niskanen RO, Ristkari SK, Korkala O, Mokka RE. Simple ligation vs stump inversion in appendicectomy. Ann Chir Gynaecol, 1996; 85(3): 222-4.

Das HP, Wilson SJ, Khan S, Parlade S, Uy A. Appendicectomy stump : ‘to bury or not to bury’. Trop Doct.1989; 19(3): 108-9.

Naeem S, Khalid I, Appendicectomy: Non-invagination vs. invagination of appendicular stump. The professional 2004;11(2):117-20.