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

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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.

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Conflict of interest

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

Author information

Authors and Affiliations

  1. Department of Surgery, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia

    Mislav Rakić, Robert Kliček & Leonardo Patrlj

  2. University of Split, School of Medicine, Šoltanska 2, 21000, Split, Croatia

    Miro Jukić

  3. Department of Pediatric Surgery, Split University Hospital Centre, Spinčićeva 1, 21000, Split, Croatia

    Zenon Pogorelić

  4. Department of Pathology, Split University Hospital Centre, Spinčićeva 1, 21000, Split, Croatia

    Ivana Mrklić

  5. Department of Surgery, Split University Hospital Centre, Spinčićeva 1, 21000, Split, Croatia

    Nikica Družijanić & Zdravko Perko

Authors
  1. Mislav Rakić
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  2. Miro Jukić
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  3. Zenon Pogorelić
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  4. Ivana Mrklić
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  5. Robert Kliček
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  6. Nikica Družijanić
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  7. Zdravko Perko
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  8. Leonardo Patrlj
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Corresponding author

Correspondence to Zenon Pogorelić.

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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

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

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