Endoloop versus endostapler closure of the appendiceal stump in pediatric laparoscopic appendectomy

Abstract

Background: There is little information available to inform choice of technique for appendiceal stump control in pediatric laparoscopic appendectomy (LA). We compared complications (stump leak, intra-abdominal abscess formation [IAA], surgical site infection [SSI]) in children undergoing LA for perforated (PA) and nonperforated appendicitis (NPA) by technique of appendiceal stump control.Methods: All children who underwent LA for confirmed acute appendicitis between 2006 and 2009 were reviewed. Choice of stump control (endoloop [EL] or endostapler [ES]) was determined by surgeon preference. Interactions between stump closure techniques and other potential confounders (intra-abdominal drain, irrigation, different antibiotic regimens) were explored using a logistic regression model. Results:Of 242 patients undergoing LA, 57 (23.6%) had PA. In the PA group the appendiceal stump was closed with EL in 47 (82.5%) patients, while in the NPA group EL was used in 161 (87%) patients. Among PA patients, IAA was more common in the ES than the EL group (5 of 10 [50%] v. 6 of 47 [12.7%]). There was no significant difference in rates of SSI. Among NPA patients, there were no differences in rates of IAA or SSI. There were no stump leaks in either group. Logistic regression analysis confirmed the predictive effect of ES use on IAA formation in PA (adjusted odds ratio 7.09; 95% confidence interval 1.08-46.13; p = 0.042). Conclusion:Our data suggest that in most cases of PA, the appendiceal stump can be safely controlled with EL. Within the PA group, the higher rates of IAA seen in ES patients may be attributable to the quality of the appendiceal stump rather than the technique of closure. Résultats : Sur 242 patients qui ont subi une AL, 57 (23,6 %) avaient une AP. Chez les patients qui avaient une AP, le moignon de l'appendicite a été refermé par ligature EL dans 47 cas (82,5 %), tandis qu'on a utilisé la ligature EL chez 161 (87 %) des patients qui avaient une ANP. Chez les patients qui avaient une AP, l'ICO était plus fréquente chez ceux qui ont reçu des agrafes ES que chez ceux qui ont reçu une ligature EL (5 sur 10 [50 %] c. 6 sur 47 [12,7 %]). Il n'y avait pas de différence significative sur le plan des taux d'ICO. Chez les patients qui avaient une ANP, on n'a constaté aucune différence quant au taux d'apparition d'un AIA ou d'une ICO. Il n'y avait pas de fuite au niveau du moignon chez les membres des 2 groupes. L'analyse par régres-sion logistique a confirmé l'effet prédicteur de l'utilisation de l'agrafe ES sur l'apparition d'AIA dans les cas d'AP (ratio d'incidence ajusté 7,09; intervalle de confiance à 95 %, 1,08-46,13; p = 0,042).

Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses

“…Less pain, lower rates of wound infection and shorter hospital stay, due to reduced surgical trauma, are advantages [19][20][21]. However, the safest endoscopic technique to close the appendiceal stump remains debateable [7,[22][23][24]. Intraabdominal abscesses are known to be the most common surgical complication following an endoscopic appendectomy procedure [4,25], and might be influenced directly by the closure technique as well as by the occurrence of perforation of the appendicitis.…”

Comparison the effect of stump closure by endoclips versus endoloop on the duration of surgery and complications in patients under laparoscopic appendectomy: A randomized clinical trial

“…[17] The hospitalization period was 1.6 days in our study which is a bit lesser than the mentioned study but no serious complications were seen after or during the surgery, only one case of infection and one case of the clips falling off. Another study examined 242 patients who had undergone laparoscopic appendectomy and indicated that endoloop is efficient and safe, especially in cases where the perforation is highly likely to occur;[18] this method also proved to be safe in our study.…”

Cost Comparison between Laparoscopic and Open Appendectomies in Children = مقارنة بين تكلفة عمليات إستئصال الزائدة عن طريق فتح البطن و المناظير عند الأطفال

“…For example, the results of two ports 15,16 or a single 'all-in-one' port appendectomies are promising, as reported by Visnjic et al and Stylianos et al 11,17 As these studies demonstrate, the cost of a single port appendectomy is less than that of an appendectomy using 3 ports. Similarly, the use of a single ENDOLOOP® or endo stapler, 18 and avoiding the use of harmonic scalpels, are other possible ways to reduce the cost of LA. The use of an endo stapler with polymeric clips has been shown to be safe, as well as reducing operative time.…”

“…The use of an endo stapler with polymeric clips has been shown to be safe, as well as reducing operative time. 18 Appropriate patient evaluations and same day discharges may also help to reduce the duration and cost of hospital stays. 19,20 …”