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

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Appendix

The members of the group are collaborators of the study: van Acker GJD, Akkermans B, Akkersdijk GJM, Algie GD, Allema JH, Andeweg CS, Appeldorn N, van Baal JG, den Bakker CM, Bartels SAL, van den Berg C, Boekestijn B, den Boer FC, Boerma D, Bolmers MDM, van den Boom AL, Boute MC, Bouwense SAW, Bransen J, van Brussel FA, Busch ORC, de Castro SMM, Cense HA, Croese C, van Dalen T, Dawson I, van Dessel E, Dettmers R, Dhar N, Dohmen FYM, van Dongen KW, van Duijvendijk P, Dulfer RR, Dwars BJ, Eerenberg JP, van der Elst M, van den Ende E, Fassaert LMM, Fikkers JT, Foppen JW, Furnee EJB, Garssen FP, Gerhards MF, van Goor H, Gorter RR, de Graaf JS, Graat LJ, Groote J, van der Ham A, Hamming JF, Hamminga JTH, van der Harst E, Heijne A, Heikens JT, Heineman E, Heemskerk J, Heij HA, Hertogs R, van Heurn E, van den Hil LCL, Hoofwijk AGM, Hulsker CCC, Hunen DRM, Ibelings MS, Klaase JM, Klicks R, Knaapen L, Kortekaas RTJ, Kruyt F, Kwant S, Lases SS, Lettinga T, Loupatty A, Matthijsen RA, Minnee RC, Mirck B, Mitalas L, Moes D, Moorman AM, Nieuwenhuijs VB, Nieuwenhuijzen GAP, Nijk PD, Omloo JMT, Ottenhof AG, Palamba HW, van der Peet DL, Pereboom ITA, Plaisier PW, van der Ploeg APT, Raber M, Reijnen MMPJ, Rijna H, Rosman C, Roumen RMH, Schmitz RF, Schouten van der Velden AP, Schreurs WH, Sigterman TA, Smeets HJ, Sonneveld DJA, Sosef MN, Spoor SF, Stassen LPS, van Steensel L, Stortelder E, Straatman J, van Susante HJ, Suykerbuyk de Hoog DENM, Terwisscha van Scheltinga C, Toorenvliet BR, Verbeek BM, Verbeek PCM, Verseveld M, Volders JH, Vriens MR, Vriens PWHE, Vrouenraets BC, van de Wall BJM, Wegdam JA, Westerduin E, Wever JJ, Winkel TA, Wijffels NAT, Wijnhoven BPL, van der Zee DC, Zeillemaker AM, Zietse C.