Effectiveness of different appendiceal stump closure methods in laparoscopic appendectomy in children: A systematic review and network meta-analysis
Bibliographic record
Abstract
BACKGROUND Laparoscopic appendectomy (LA) is the standard treatment for acute appendicitis in children, offering reduced postoperative pain and quicker recovery compared to open surgery. A critical aspect of LA is the secure closure of the appendiceal stump to avoid complications such as leakage and abscess formation. Various closure techniques are employed, including endoloops (ELs), staplers, clips, and energy devices; however, the optimal method remains unclear due to inconsistent evidence. AIM To systematically evaluate and rank the effectiveness and safety of different appendiceal stump closure techniques used in pediatric LA. By assessing outcomes such as postoperative complications, operative time, and length of hospital stay, this analysis seeks to provide evidence-based guidance to clarify clinical decision-making and optimize patient care. METHODS This systematic review and network meta-analysis, conducted according to PRISMA and Cochrane guidelines, compared the effectiveness and safety of stump closure methods in pediatric LA. Databases searched included PubMed, Cochrane Central, Web of Science, and Scopus up to May 1, 2025. Eligible studies included both randomized and non-randomized designs reporting surgical outcomes in pediatric patients. Two reviewers independently extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale. A frequentist network meta-analysis with a random-effects model was conducted using R software to evaluate total complications (primary outcome), as well as operative time and hospital stay (secondary outcomes). P -scores were used to rank the effectiveness of treatments. RESULTS Fourteen studies comprising over 50000 pediatric patients were included in the network meta-analysis comparing appendiceal stump closure techniques in LA. No significant differences in total postoperative complications or hospital stay were observed among techniques, including EL, endostapler, polymer clip, LigaSure, harmonic scalpel (HS), and sutures. HS showed a statistically significant reduction in operative time compared to EL (mean difference: -13.5 minutes), while other methods did not demonstrate significant time savings. No technique was associated with a statistically significant increase or decrease in postoperative complications or length of stay. Publication bias was minimal, and the methodological quality of included studies was moderate to good. CONCLUSION While all closure techniques show similar safety profiles, HS offers shorter operating times. These findings support tailoring stump closure method selection based on operative efficiency and resource availability.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.039 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.043 |
| Bibliometrics | 0.010 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".