Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling?
BACKGROUND
This metaanalysis aimed to compare endoscopic linear stapling and loop ligatures used to secure the base of the appendix.


METHODS
Randomized controlled trials on appendix stump closure during laparoscopic appendectomy were systematically searched and critically appraised. The results in terms of complication rates, operating time, and hospital stay were pooled by standard metaanalytic techniques.


RESULTS
Data on 427 patients from four studies were included. The operative time was 9 min longer when loops were used (p = 0.04). Superficial wound infections (odds ratio [OR], 0.21; 95% confidence interval (CI), 0.06-0.71; p = 0.01) and postoperative ileus (OR, 0.36; 95% CI, 0.14-0.89; p = 0.03) were significantly less frequent when the appendix stump was secured with staples instead of loops. Of 10 intraoperative ruptures of the appendix, 7 occurred in loop-treated patients (p = 0.46). Hospital stay and frequency of postoperative intraabdominal abscess also were comparable in loop-treated and staple-treated patients.


CONCLUSIONS
The clinical evidence on stump closure methods in laparoscopic appendectomy favors the routine use of endoscopic staplers.
Kazemier
G
G
Department of Surgery, Erasmus Medical Centre Rotterdam, Dr Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.
in't Hof
K H
KH
Saad
S
S
Bonjer
H J
HJ
Sauerland
S
S
D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D045823:Ileus / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D013528:Surgical Staplers; D013530:Surgical Wound Infection / Q000453:epidemiology; D013536:Suture Techniques; D013997:Time Factors