Abstract
Purpose
An inadequate closure of the appendiceal stump can lead to intra-abdominal surgical site infections. The aim of this study was to assess the efficiency of different closure techniques by focusing on the intraoperative and postoperative complications versus cost.
Methods
From June 2011 to June 2013, 333 patients from two different hospitals undergoing laparoscopic appendectomy were included in this study. The patients were divided into two groups based on the technique used for appendiceal stump closure: there were 104 patients in the stapler group and 229 in the loop group.
Results
Among the 333 patients who underwent laparoscopic appendectomy, there were two (0.6 %) intraoperative complications and 22 (6.6 %) postoperative complications. There were no significant differences between the groups with respect to the intraoperative and postoperative complications. The length of the operation was 7 min shorter when the endoloop was used (p = 0.014). The mean costs of the operation were significantly lower when the loop was used (€ 554.93) compared to the stapler (€ 900.70) (p = 0.000).
Conclusions
There is no clinical evidence supporting the routine use of endoscopic staplers. The appendiceal stump can be secured safely with the use of endoloops in the majority of patients. Surgeons have to be more selective when choosing how to perform closure, and an endostapler should be used only in cases where it is clinically indicated.
Similar content being viewed by others
References
Yaghoubian A, Kaji AH, Lee SL. Laparoscopic versus open appendectomy: outcomes analysis. Am Surg. 2012;78:1083–6.
Rashid A, Nazir S, Kakroo SM, Chalkoo MA, Razvi SA, Wani AA. Laparoscopic interval appendectomy versus open interval appendectomy: a prospective randomized controlled trial. Surg Laparosc Endosc Percutan Tech. 2013;23:93–6.
Beldi G, Muggli K, Helbling C, Schlumpf R. Laparoscopic appendectomy using endoloops: a prospective, randomized clinical trial. Surg Endosc. 2004;18:749–50.
Pogorelić Z, Stipić R, Družijanić N, Perko Z, Grandić L, Vilović K, et al. Torsion of epiploic appendage mimic acute appendicitis. Coll Antropol. 2011;35:1299–302.
Perko Z, Bilan K, Pogorelić Z, Družijanić N, Sršen D, Kraljević D, et al. Acute appendicitis and ileal perforation with a toothpick treated by laparoscopy. Coll Antropol. 2008;32:307–9.
Beldi G, Vorburger SA, Bruegger LE, Kocher T, Inderbitzin D, Candinas D. Analysis of stapling versus endoloops in appendiceal stump closure. Br J Surg. 2006;93:1390–3.
Wagner M, Aronsky D, Tschudi J, Metzger A, Klaiber C. Laparoscopic stapler appendectomy. A prospective study of 267 consecutive cases. Surg Endosc. 1996;10:895–9.
Safavi A, Langer M, Skarsgard ED. Endoloop versus endostapler closure of the appendiceal stump in pediatric laparoscopic appendectomy. Can J Surg. 2012;55:37–40.
Fahrner R, Schöb O. Laparoscopic appendectomy as a teaching procedure: experiences with 1,197 patients in a community hospital. Surg Today. 2012;42:1165–9.
Miyano G, Urao M, Lane GJ, Kato Y, Okazaki T, Yamataka A. A prospective analysis of endoloops and endostaples for closing the stump of the appendix in children. J Laparoendosc Adv Surg Tech A. 2011;21:177–9.
Kazemier G, in’t Hof KH, Saad S, Bonjer HJ, Sauerland S. Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling? Surg Endosc. 2006;20:1473–6.
Nottingham JM. Mechanical small bowel obstruction from a loose linear cutter staple after laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech. 2002;12:289–90.
Chepla KJ, Wilhelm SM. Delayed mechanical small bowel obstruction caused by retained, free, intraperitoneal staple after laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech. 2011;21:e19–20.
Pogorelić Z, Biočić M, Jurić I, Milunović KP, Mrklić I. Acute appendicitis as a complication of varicella. Acta Medica (Hradec Králové). 2012;55:150–2.
Sahm M, Kube R, Schmidt S, Ritter C, Pross M, Lippert H. Current analysis of endoloops in appendiceal stump closure. Surg Endosc. 2011;25:124–9.
Arcovedo R, Barrera H, Reyes HS. Securing the appendiceal stump with the Gea extracorporeal sliding knot during laparoscopic appendectomy is safe and economical. Surg Endosc. 2007;21:1764–7.
Billingham MJ, Basterield SJ. Pediatric surgical technique: laparoscopic or open approach? A systematic review and meta-analysis. Eur J Pediatr Surg. 2010;20:73–7.
Kouwenhoven EA, Repelaer van Driel OJ, van Erp WF. Fear for the intraabdominal abscess after laparoscopic appendectomy: not realistic. Surg Endosc. 2005;19:923–6.
Tanaka S, Kubota D, Lee SH, Oba K, Matsuyama M. Effectiveness of laparoscopic approach for acute appendicitis. Osaka City Med J. 2007;53:1–8.
Rickert A, Bönninghoff R, Post S, Walz M, Runkel N, Kienle P. Appendix stump closure with titanium clips in laparoscopic appendectomy. Langenbecks Arch Surg. 2012;397:327–31.
Gomes CA, Nunes TA, Soares C Jr, Gomes CC. The appendiceal stump closure during laparoscopy: historical, surgical, and future perspectives. Surg Laparosc Endosc Percutan Tech. 2012;22:1–4.
Hanssen A, Plotnikov S, Dubois R. Laparoscopic appendectomy using a polymeric clip to close the appendicular stump. JSLS. 2007;11:59–62.
Sajid MS, Rimple J, Cheek E, Baig MK. Use of endo-GIA versus endo-loop for securing the appendicular stump in laparoscopic appendicectomy: a systematic review. Surg Laparosc Endosc Percutan Tech. 2009;19:11–5.
Chu T, Smith PC, Chandhoke RA, Schwaitzberg SD. The impact of surgeon choice on the cost of performing laparoscopic appendectomy. Surg Endosc. 2011;25:1187–91.
Conflict of interest
Mislav Rakić and co-authors have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rakić, M., Jukić, M., Pogorelić, Z. et al. Analysis of endoloops and endostaples for closing the appendiceal stump during laparoscopic appendectomy. Surg Today 44, 1716–1722 (2014). https://doi.org/10.1007/s00595-013-0818-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-013-0818-8