Stump appendicitis is extremely rare and there have been a few case reports and small series in the literature (most of them after open appendectomy). It is believed by some that there might be a potential for an increased incidence of stump appendicitis in laparoscopic surgery due to the lack of a three dimensional perspective and the inability to palpate the base of the cecum by the surgeon. If a long stump is left behind, it may lead to recurrent stump appendicitis. However, about two thirds of the cases reported in the literature have been after open appendectomy. For that reason, it is reasonable to assume that if laparoscopic appendectomy is performed correctly, stump appendicitis should not develop.

Nice question. Evidently I don't have the answer and it is difficult to make a research nowadays since normally almost all cases should be done laparoscopically. I would assume that: 1. By laparoscopy the magnification helps to leave smaller stumps. 2. If open surgery is performed, this would mean more serious inflammation and leaving on purpose longer stumps can be more possible. 3. It is logic to have more open in the longer stump group in the literature since in total many more appendicetomies up to now have been performed by open. In anyway, reoperation ("stumpectomie!") I would say that it could be done by laparoscopy 

In my opinion this should not happen or the technique is poor!

It is like leaving a stump of gallbladder instead of taking it out altogether!

As a crossover surgeon trained in the open appendectomy era and now practicing in the laparoscopic era I am inclined to think that those appendices that are anatomically subserosal and in the presence of excess mesoappendiceal fat, laparoscopic appendectomy would favour inadvertently leaving a longer stump than open appendectomy but that is not to say that the open method will see a resurgence in comeback for that reason alone or for any reason for that matter.

We can understand the stump appendicitis if we think that a fecalith may impact in a long stump inadvertently left in the "first" appendectomy, causing an appendicitis the same way it would do in a full appendix. Lack of experience more than lack of three dimensional perspective will lead you to leave a longer stump because you fear a cecal injury, of example. My advice is: if you don't have the skills or if the operation is really difficult and you can't get over it with an extra port, convert to open surgery!

On the original question, the frequency of stump appendicitis will depend less on the method of operating it rather than on the experience and the wisdom of the surgeon. By the way, we must not underrate appendectomy - it may be the both the easiest AND the hardest operation a surgeon performs.

As a friendly comment on the words of Dr. Domenico Piccolboni and Dr. Andre Hebra last phrase: even a well performed, perfect operation may be liable to complications for reasons that stay out of the surgeon's control.

Аппендицит культи червеобразного отростка в эру лапароскопической хирургии крайне редкая патология. яяяяяяяяв моей практике с 1996 года был лишь один случай у 67 летней женщины, через три года после открытой аппендэктомии, при этом основание культи аппендикса было интимно спаяно со стенкой слепой кишки и культя аппендикса была до 2 см длиной. После этого млучая с 1999 года больше не было пациентов с такой патологией.

Thankyou,can it be possible to translate your answer in English Please,

Hi Prasanna. Interesting question. I cannot remember seeing a stump appendicitis, but looking at what you've described from the CT report, this appears more of an appendicitis post subtotal appendicectomy (2 cm segment) than stump appendicitis.

Stump appendicitis vermiform process in the era of laparoscopic surgery are extremely rare pathology.  my practice in 1996 there was only one case in a 67-year-old woman, three years after open appendectomy, while the base of the stump of the Appendix was intimately fused with the wall of the caecum and the stump of the Appendix was up to 2 cm in length. After that Luca 1999 there were no more patients with this pathology.

Stump appendicitis vermiform process in the era of laparoscopic surgery are extremely rare pathology. in my practice since 1996 there was only one case in a 67-year-old woman, three years after open appendectomy, while the base of the stump of the Appendix was intimately fused with the wall of the caecum and the stump of the Appendix was up to 2 cm in length. After this incident since 1999 there were no more patients with this pathology.

I have operated two cases of stump appendicitis. Rather, I have seen and operated a number of cases where the surgeon had left the full appendix.whether it is open or lap, it is likely to leave a long stump if one is not able to appreciate the base due to inexperience or due to a lot of inflammation at the base, the surgeon knowingly tends to leave a longer stump to be on safer side. 

In my experience, I had to face stump appendicitisonly once. The patient had undergone lap appendectomy elsewhere six months before. Cure was obtained by lap stumpectomy. I am not sure if laparoscopy favours an excess in length of the appendiceal stump,  nevertheless stump appendicitis is extremely rare.

Agree with previous comments: rare, probably due to more inexperienced surgeons (learning curve!) in particular when the appendix is intra-serous. So it's very important to see the enlargement of the base of the appendix into the caecum before ligation.Did you know that stump appendicitis was also descibed during laparotomy?!

Conclusion: I always ask my younger colleagues to have a last look to the stump and the area of the appendicular artery before exsufflation.

Stump appendicitis are and should be very rare in laparoscopic era. This is a condition seen only in the early stage of the learning curve.

Dr Deepraj,

Thankyou very much