A 35-year-old man undergoes emergency appendectomy for acute appendicitis. Intraoperatively, the appendix is found to be inflamed with a small perforation and localized purulent collection. Regarding the management and complications of acute appendicitis, all of the following statements are correct EXCEPT:

Explanation

## Management and Complications of Acute Appendicitis ### Correct Answer: "Appendiceal stump invagination reduces the risk of postoperative stump leak and is mandatory in all appendectomy cases" **Key Point:** Appendiceal stump invagination is a technique that may reduce stump leak risk, but it is NOT mandatory in all cases. Modern practice shows that simple ligation without invagination is safe and widely accepted, especially in uncomplicated appendicitis. **Clinical Pearl:** Stump invagination (burying the appendiceal stump under the cecal serosa) was historically performed to prevent leak, but prospective studies and meta-analyses show no significant difference in stump leak rates between invaginated and non-invaginated stumps in uncomplicated appendicitis. It is an optional technique, not a standard requirement. **High-Yield:** The trend in modern appendectomy is toward simplification — simple ligation or stapling of the appendiceal base is sufficient and reduces operative time without increasing complications. ### Why the Other Options Are Correct | Statement | Truth | Explanation | |-----------|-------|-------------| | Laparoscopic vs. open SSI | TRUE | Laparoscopic appendectomy has lower surgical site infection rates (~2–4%) compared to open appendectomy (~5–8%) in uncomplicated cases, due to smaller incisions and reduced tissue trauma. | | Perforated appendicitis management | TRUE | Perforation with generalized peritonitis is a surgical emergency requiring immediate appendectomy, source control, and broad-spectrum antibiotics (covering gram-negative and anaerobic organisms, e.g., ceftriaxone + metronidazole or piperacillin-tazobactam). | | Interval appendectomy timing | TRUE | Patients with appendiceal mass/abscess who respond to conservative management (antibiotics, percutaneous drainage if needed) are candidates for interval appendectomy after 6–8 weeks to allow inflammation to resolve and reduce operative morbidity. | **Warning:** Do not confuse "optional technique" with "never done." Stump invagination is still performed by some surgeons as a belt-and-suspenders approach, but it is not mandatory. **Mnemonic:** **SIMPLE** = Stump invagination is **Mostly** not **Indicated** in **Practical** **Laparoscopic** **Appendectomy**. [cite:Sabiston Textbook of Surgery 21e Ch 51; Cochrane Database Syst Rev 2020]