title: Analysis of stapling versus endoloops in appendiceal stump closure.
abstract: BACKGROUND
  The effectiveness of various appendiceal stump closure methods has not been evaluated systematically. The aim of this study was to compare the morbidity of stump closure by stapling or use of endoloops.
  
  
  METHODS
  A non-concurrent cohort study of prospectively acquired data was performed. The primary outcome variable was the rate of intra-abdominal surgical-site infection. Secondary outcome measures were complications, duration of intervention, hospital stay, rate of readmission to hospital and the difference in direct costs of the operation.
  
  
  RESULTS
  Staples were used in 60.5 per cent and endoloops in 39.5 per cent of 6486 patients operated on for suspected appendicitis between January 1995 and December 2003. Among 4489 patients with acute appendicitis the rate of intra-abdominal surgical-site infection was 0.7 per cent in the stapler group and 1.7 per cent in the endoloop group (P = 0.004). The rate of readmission to hospital was 0.9 and 2.1 per cent respectively (P = 0.001).
  
  
  CONCLUSIONS
  Application of a stapler for transection and closure of the appendiceal stump in patients with acute appendicitis lowered the risk of postoperative intra-abdominal surgical-site infection and the need for readmission to hospital.
authors.affiliation: Department of Visceral and Transplant Surgery, University Hospital Bern, Bern, Switzerland. guido.beldi@insel.ch
authors.forename: G
authors.initials: G
authors.lastname: Beldi
authors.forename: S A
authors.initials: SA
authors.lastname: Vorburger
authors.forename: L E
authors.initials: LE
authors.lastname: Bruegger
authors.forename: T
authors.initials: T
authors.lastname: Kocher
authors.forename: D
authors.initials: D
authors.lastname: Inderbitzin
authors.forename: D
authors.initials: D
authors.lastname: Candinas
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000191:economics / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D006801:Humans; D007902:Length of Stay; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology*; D011446:Prospective Studies; D017792:Surgical Stapling / Q000191:economics; D013530:Surgical Wound Infection / Q000191:economics / Q000209:etiology; D013536:Suture Techniques / Q000191:economics; D016896:Treatment Outcome