Surgical Endoscopy

, Volume 31, Issue 1, pp 178–184 | Cite as

Endoloops or endostapler use in laparoscopic appendectomy for acute uncomplicated and complicated appendicitis

No difference in infectious complications
  • Charles C. van Rossem
  • Anna A.W. van Geloven
  • Marc H.F. Schreinemacher
  • Willem A. Bemelman
  • On behalf of the snapshot appendicitis collaborative study group



The most appropriate closure for the appendicular stump with either endoloops or an endostapler in laparoscopic appendectomy remains unclear and under debate because of limited and conflicting evidence.


In a 2-month prospective, observational, resident-led nationwide cohort study, patients undergoing laparoscopic appendectomy for both uncomplicated and complicated appendicitis were analysed. Logistic regression analyses were performed for identifying the possible effect of stump closure type and other risk factors for infectious complications.


Laparoscopic appendectomy for acute appendicitis was performed in 1369 patients in 62 hospitals; endoloops were used in 76.7 % and an endostapler in other patients. Median operating time was not different between endoloop and endostapler use (42.0 vs. 44.0 min, P = 0.243). A superficial surgical site infection was seen in 2.0 % after uncomplicated appendicitis and in 0.8 % after complicated appendicitis. The intra-abdominal abscess rate was 1.9 % after uncomplicated and 11.0 % after complicated appendicitis. No significant effect of stump closure type was observed for any infectious complication (OR 1.05; 95 % CI 0.625–1.766, P = 0.853) or an intra-abdominal abscess (OR OR 0.96; 95 % CI 0.523–1.768, P = 0.899). In multivariable analysis, complicated appendicitis was identified as the only independent risk factor for an intra-abdominal abscess (OR 6.26; 95 % CI 3.454–11.341, P < 0.001).


The infectious complication rate is not influenced by the type of appendicular stump closure with either endoloops or an endostapler in this study. If technically feasible, closure with endoloops is advised for cost considerations.


Appendicitis Appendectomy Laparoscopic Endoloop Endostapler 


Compliance with ethical standards


CC. van Rossem, A.A.W. van Geloven, M.H.F. Schreinemacher, W.A. Bemelman and the members of the collaborative study group have no conflict of interest or financial ties to disclose.


  1. 1.
    Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 6(10):CD001546Google Scholar
  2. 2.
    Kazemier G, in’t Hof KH, Saad S, Bonjer HJ, Sauerland S (2006) Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling? Surg Endosc 20:1473–1476CrossRefPubMedGoogle Scholar
  3. 3.
    Sajid MS, Rimple J, Cheek E, Baig MK (2009) Use of endo-GIA versus endo-loop for securing the appendicular stump in laparoscopic appendicectomy: a systematic review. Surg Laparosc Endosc Percutan Tech 19:11–15CrossRefPubMedGoogle Scholar
  4. 4.
    Swank HA, van Rossem CC, van Geloven AA, in’t Hof KH, Kazemier G, Meijerink WJ, Lange JF, Bemelman WA (2014) Endostapler or endoloops for securing the appendiceal stump in laparoscopic appendectomy: a retrospective cohort study. Surg Endosc 28:576–583CrossRefPubMedGoogle Scholar
  5. 5.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457CrossRefGoogle Scholar
  6. 6.
    Bakker OJ, Go PM, Puylaert JB, Kazemier G, Heij HA, Werkgroep richtlijn Diagnostiek en behandeling van acute appendicitis (2010) Guideline on diagnosis and treatment of acute appendicitis: imaging prior to appendectomy is recommended. Ned Tijdschr Geneeskd 154:A303Google Scholar
  7. 7.
    Gorter RR, Heij HA, Eker HH, Kazemier G (2014) Laparoscopic appendectomy: state of the art. Tailored approach to the application of laparoscopic appendectomy? Best Pract Res Clin Gastroenterol 28:211–224CrossRefPubMedGoogle Scholar
  8. 8.
    Beldi G, Vorburger SA, Bruegger LE, Kocher T, Inderbitzin D, Candidas D (2006) Analysis of stapling versus endoloops in appendiceal stump closure. Br J Surg 93:1390–1393CrossRefPubMedGoogle Scholar
  9. 9.
    Miyano G, Urao M, Lane GJ, Kato Y, Okazaki T, Yamataka A (2011) A prospective analysis of endoloops and endostaples for closing the stump of the appendix in children. J Laparoendosc Adv Surg Tech 21:177–179CrossRefGoogle Scholar
  10. 10.
    Miyano G, Urao M, Lane GJ, Kato Y, Okazaki T, Yamataka A (2011) Appendiceal stump closure in children with complicated appendicitis: a prospective analysis of endoloops versus endostaplers. Asian J Endosc Surg 4:116–119CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Charles C. van Rossem
    • 1
  • Anna A.W. van Geloven
    • 1
  • Marc H.F. Schreinemacher
    • 2
  • Willem A. Bemelman
    • 2
  • On behalf of the snapshot appendicitis collaborative study group
  1. 1.Department of surgeryTergooi HospitalHilversumThe Netherlands
  2. 2.Department of surgeryAcademic Medical CenterAmsterdamThe Netherlands

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