Current analysis of endoloops in appendiceal stump closure.
BACKGROUND
An inadequate closure of the appendix stump leads to intra-abdominal surgical site infection. The effectiveness of various appendiceal stump closure methods, for instance, staplers or endoloops, was evaluated. Many analyses show that the use of a stapler for transection and closure of the appendiceal stump lowers the risk of this infection but a statistically significant risk of postoperative intra-abdominal abscess or wound infection was not considered in any randomized study. The aim of this study was to evaluate the complications after using endoloops in a high-volume center.


METHODS
The data of 1,790 patients who underwent laparoscopic appendectomy between January 1998 and December 2006 and a single center was prospectively acquired. The standard procedure used was an appendiceal stump closure using endoloops and a selective use of staplers. The outcome criteria for inclusion in the study were intra-abdominal abscess formations, other specific intraoperative and postoperative complications, and the different costs of the operation.


RESULTS
Laparoscopic appendectomy was performed in 1,790 (80.8%) patients and open appendectomy in 425 (19.2%) patients. Conversion to open surgery occurred in 74 (4.13%) patients. Laparoscopic appendectomy with stump closure using endoloops was performed in 1,670 (97.3%) patients and stump closure using a stapler in 46 (2.7%) patients. Among 851 patients with acute appendicitis, 284 patients with perforated appendicitis, and 535 patients with other or no pathology, the rate of intra-abdominal abscess after using an endoloop or a stapler was not significantly different (1.5 vs. 0%, p = 0.587; 3.5 vs. 4.2%, p = 0.870; 0.7% vs. 0, p = 0.881, respectively). There were no significant differences between the endoloop group and the stapler group with respect to the other specific intraoperative and postoperative complications.


CONCLUSIONS
This study shows the safety of the endoloop for clinical daily routine. A selective procedure for stump closure has been established. Appendiceal stump closure using an endoloop is an easy, safe, and cost-effective procedure.
Sahm
Maik
M
Department of Surgery, DRK Kliniken Berlin Köpenick, Klinik für Chirurgie, Salvador Allende Straße 2-8, 12559, Berlin, Germany. m.sahm@drk-kliniken-berlin.de
Kube
Rainer
R
Schmidt
Sybille
S
Ritter
Christina
C
Pross
Matthias
M
Lippert
Hans
H
D018784:Abdominal Abscess / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery; D002648:Child; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D017792:Surgical Stapling; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D013536:Suture Techniques / Q000191:economics / Q000295:instrumentation; D055815:Young Adult