Surgery Today

, Volume 44, Issue 9, pp 1716–1722 | Cite as

Analysis of endoloops and endostaples for closing the appendiceal stump during laparoscopic appendectomy

  • Mislav Rakić
  • Miro Jukić
  • Zenon Pogorelić
  • Ivana Mrklić
  • Robert Kliček
  • Nikica Družijanić
  • Zdravko Perko
  • Leonardo Patrlj
Original Article



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.


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.


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).


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.


Appendicitis Laparoscopic appendectomy Appendiceal stump closure Endoloop Stapler 


Conflict of interest

Mislav Rakić and co-authors have no conflict of interest.


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Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Mislav Rakić
    • 1
  • Miro Jukić
    • 2
  • Zenon Pogorelić
    • 3
  • Ivana Mrklić
    • 4
  • Robert Kliček
    • 1
  • Nikica Družijanić
    • 5
  • Zdravko Perko
    • 5
  • Leonardo Patrlj
    • 1
  1. 1.Department of SurgeryUniversity Hospital DubravaZagrebCroatia
  2. 2.University of Split, School of MedicineSplitCroatia
  3. 3.Department of Pediatric SurgerySplit University Hospital CentreSplitCroatia
  4. 4.Department of PathologySplit University Hospital CentreSplitCroatia
  5. 5.Department of SurgerySplit University Hospital CentreSplitCroatia

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