Is the use of endoloops safe and efficient for the closure of the appendicular stump in complicated and uncomplicated acute appendicitis?
- 7 January 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Langenbecks Archiv für Chirurgie
- Vol. 406 (5), 1581-1589
- https://doi.org/10.1007/s00423-020-02050-3
Abstract
Introduction There is still controversy regarding the ideal technique to close the appendicular stump in laparoscopic appendectomy (LA). The objective of this study was to determine the safety and efficiency of the use of an endoloop (EL) and endostapler (ES) in complicated and uncomplicated acute appendicitis. Methods Retrospective cohort study of patients undergoing LA from February 2013 to December 2019. Acute uncomplicated and complicated appendicitis were analysed separately, establishing two groups according to the stump closure technique: EL or ES. Seven hundred-nine patients were included (535 uncomplicated and 174 complicated). In uncomplicated appendicitis, an EL was used in 447 of the patients (83.55%) and an ES was used in 88 patients (16.45%). In complicated appendicitis, an EL was used in 85 patients (48.85%) and an ES was used in 89 patients (51.15%). An analysis of effectiveness and a cost analysis of each technique were performed. Results In uncomplicated appendicitis, we found no differences with respect to global complications, although there were significant differences in the total mean hospital stay (EL group 1.55 (SD 1.48) days; ES group 2.21 (SD 1.69) days; p = 0.046). This meant a savings of 514.12€ per patient using the EL p < 0.001). In complicated appendicitis, the reoperations classified as Clavien-Dindo IIIB in the EL group (6.4%) were greater than in the ES group (0%) (p = 0.012), although the rate of postoperative abscesses (p = 0.788) and the mean volume of abscesses (p = 0.891) were similar. Conclusion The systematic use of an EL could reduce costs in uncomplicated appendicitis, while in complicated cases, both options are valid. Prospective studies with a greater number of patients are needed to observe differences in postoperative complications.This publication has 30 references indexed in Scilit:
- Comparison of Various Methods of Mesoappendix Dissection in Laparoscopic AppendectomyJournal of Laparoendoscopic & Advanced Surgical Techniques, 2014
- Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study)World Journal of Emergency Surgery, 2013
- Appendiceal stump closure in children with complicated appendicitis: A prospective analysis of endoloops versus endostaplesAsian Journal of Endoscopic Surgery, 2011
- A Prospective Analysis of Endoloops and Endostaples for Closing the Stump of the Appendix in ChildrenJournal of Laparoendoscopic & Advanced Surgical Techniques, 2011
- Delayed Mechanical Small Bowel Obstruction Caused by Retained, Free, Intraperitoneal Staple After Laparoscopic AppendectomySurgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2011
- Offene AppendektomieDer Chirurg, 2009
- Use of Endo-GIA Versus Endo-loop for Securing the Appendicular Stump in Laparoscopic AppendicectomySurgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2009
- The “Double Endoloop” Technique—A Simple Alternative Technique for Laparoscopic AppendectomySurgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2008
- Analysis of stapling versus endoloops in appendiceal stump closureBritish Journal of Surgery, 2006
- Laparoscopic stapler appendectomySurgical Endoscopy, 1996