title: Division of the mesoappendix with electrocautery in children is safe, effective, and cost-efficient.
abstract: BACKGROUND
  Laparoscopic appendectomy is one of the most common procedures performed in children. There are several techniques available for dividing the mesoappendix including the using an endostapler, a LigaSure (Covidien, Boulder, CO), a harmonic scalpel (Ethicon Endosurgery, Cincinnati, OH), or electrocautery. Although it is the least expensive approach, many feel that electrocautery is an unsafe method of dividing the mesoappendix. Here we present our experience with the use of solely electrocautery to divide the mesoappendix.
  
  
  METHODS
  Over a period of 12 years, a total of 442 laparoscopic appendectomies were logged into our database. Each appendectomy was performed by coagulating and dividing the mesoappendix with a Maryland dissector or in some cases a hook electrocautery. Three 0-PDS Endoloops (Ethicon Endosurgery, Cincinnati, OH) were then used to ligate the base of the appendix, two proximal and one distal. Patient weight, age, operative time, perforated versus nonperforated, and intraoperative and postoperative complications were queried.
  
  
  RESULTS
  Of the 442 cases, 71 were perforated (16%). The mean time for nonperforated appendectomies was 26 minutes and 38 minutes for perforated. There was one case of postoperative bleeding managed nonoperatively in a patient with previously undiagnosed factor VIII deficiency. The cost of each endoloop was $22.
  
  
  CONCLUSIONS
  Although some have questioned the safety of using electrocautery alone to divide the mesoappendix for fear that it may not be adequate to seal the appendiceal artery, may take excessive time, or may cause collateral tissue injury, this has not been our experience. Therefore, the use of more costly instruments to divide the mesoappendix such as the endostapler, LigaSure, or harmonic scalpel seems unwarranted. This study demonstrates that electrocautery for the mesoappendix and endoloops for the appendix is safe, effective, and cost-efficient.
authors.affiliation: Department of Pediatric Surgery, Rocky Mountain Hospital for Children, Denver, CO, USA. tponsky@yahoo.com
authors.forename: Todd A
authors.initials: TA
authors.lastname: Ponsky
authors.forename: Steven S
authors.initials: SS
authors.lastname: Rothenberg
mesh_terms: D001062:Appendectomy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D001064:Appendicitis / Q000601:surgery; D002648:Child; D003365:Costs and Cost Analysis; D004564:Electrocoagulation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011183:Postoperative Complications