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Endoloop versus endostapler: what is the best option for appendiceal stump closure in children with complicated appendicitis? Results of a multicentric international survey

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Abstract

Background

There is a limited and conflicting evidence about the most appropriate method for appendiceal stump closure during laparoscopic appendectomy (LA). We aimed to compare endoloop (EL) versus endostapler (ES) for stump closure during LA for complicated perforated appendicitis in children.

Methods

We retrospectively reviewed the records of 708 patients (463 boys and 245 girls with an average age of 9.8 years) who underwent LA for complicated appendicitis in 5 international centers of Pediatric Surgery over a 5-years period (January 2011–December 2016). The appendix was perforated with localized peritonitis in 470 cases and diffuse peritonitis in 238 patients. EL was used in 374 cases (G1), whereas ES was adopted in 334 cases (G2).

Results

No intra-operative complication occurred in both groups but 5 conversions to open surgery were reported in G1 (1.3%) and 4 in G2 (1.1%) (OR 1.1; 95% CI 0.30–4.19). Use of EL was significantly associated with higher incidence of intra-abdominal abscess (OR 1.36; 95% CI 0.84–2.18), postoperative ileus (OR 3.61; 95% CI 0.76–17.11), and re-operations/readmissions (OR 6.46; 95% CI 1.46–28.62) compared to ES. The average cost of supplies for LA was significantly higher in G2 (€ 915.60) compared to G1 (€ 578.36) (p = 0.0001). The average cost of re-operations/readmissions was significantly higher in G1 (€ 4.091,39) compared to G2 (€ 2.127,88) (p = 0.0001) (OR 1.72; 95% CI 1.47–2.01).

Conclusions

Our study is the first in the pediatric population to demonstrate that the method used for appendiceal stump closure may influence the outcome of LA in complicated appendicitis. Although ES is more expensive compared to EL, our results demonstrated that appendix stump closure should be performed using ES rather than EL in complicated perforated appendicitis since its use was associated with a lower incidence of postoperative intra-abdominal abscess and postoperative ileus and lower re-operations and readmissions rates and costs.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy

    Maria Escolino & Ciro Esposito

  2. Division of Pediatric Surgery, Hopitaux Universitaires de Strasbourg, Strasbourg, France

    Francois Becmeur

  3. Division of Pediatric Surgery, Chelsea Children’s Hospital, London, UK

    Amulya Saxena

  4. Division of Pediatric Surgery, Medical University of Graz, Graz, Austria

    Holger Till

  5. Division of Pediatric Surgery, Mercy Children’s Hospital, Kansas City, MO, USA

    George W. Holcomb 3rd

Authors
  1. Maria Escolino
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  2. Francois Becmeur
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  3. Amulya Saxena
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  4. Holger Till
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  5. George W. Holcomb 3rd
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  6. Ciro Esposito
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Correspondence to Ciro Esposito.

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Disclosure

Drs Maria Escolino, Francois Becmeur, Amulya Saxena, Holger Till, George W. Holcomb 3rd, and Ciro Esposito declare that they have no conflicts of interest or financial ties to disclose.

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Escolino, M., Becmeur, F., Saxena, A. et al. Endoloop versus endostapler: what is the best option for appendiceal stump closure in children with complicated appendicitis? Results of a multicentric international survey. Surg Endosc 32, 3570–3575 (2018). https://doi.org/10.1007/s00464-018-6081-8

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  • DOI: https://doi.org/10.1007/s00464-018-6081-8

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