Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

References

  1. Yaghoubian A, Kaji AH, Lee SL. Laparoscopic versus open appendectomy: outcomes analysis. Am Surg. 2012;78:1083–6.

    PubMed  Google Scholar 

  2. 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.

    PubMed  Article  Google Scholar 

  3. Beldi G, Muggli K, Helbling C, Schlumpf R. Laparoscopic appendectomy using endoloops: a prospective, randomized clinical trial. Surg Endosc. 2004;18:749–50.

    CAS  PubMed  Article  Google Scholar 

  4. 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.

    PubMed  Google Scholar 

  5. 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.

    PubMed  Google Scholar 

  6. 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.

    CAS  PubMed  Article  Google Scholar 

  7. 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.

    CAS  PubMed  Article  Google Scholar 

  8. 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.

    PubMed Central  PubMed  Article  Google Scholar 

  9. 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.

    PubMed  Article  Google Scholar 

  10. 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.

    PubMed  Article  Google Scholar 

  11. 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.

    CAS  PubMed  Article  Google Scholar 

  12. Nottingham JM. Mechanical small bowel obstruction from a loose linear cutter staple after laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech. 2002;12:289–90.

    PubMed  Article  Google Scholar 

  13. 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.

    PubMed  Article  Google Scholar 

  14. 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.

    Google Scholar 

  15. 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.

    PubMed  Article  Google Scholar 

  16. 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.

    CAS  PubMed  Article  Google Scholar 

  17. 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.

    CAS  PubMed  Article  Google Scholar 

  18. 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.

    CAS  PubMed  Article  Google Scholar 

  19. 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.

    PubMed  Google Scholar 

  20. 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.

    PubMed Central  PubMed  Article  Google Scholar 

  21. 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.

    PubMed  Article  Google Scholar 

  22. Hanssen A, Plotnikov S, Dubois R. Laparoscopic appendectomy using a polymeric clip to close the appendicular stump. JSLS. 2007;11:59–62.

    PubMed Central  PubMed  Google Scholar 

  23. 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.

    PubMed  Article  Google Scholar 

  24. 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.

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

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

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Zenon Pogorelić.

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-013-0818-8

Keywords

  • Appendicitis
  • Laparoscopic appendectomy
  • Appendiceal stump closure
  • Endoloop
  • Stapler