title: Loop ileostomy closure: comparison of cost effectiveness between suture and stapler.
abstract: BACKGROUND
  Closure of loop ileostomy can be safely performed using sutures or staplers. The aim of the present study was to compare the cost effectiveness of three different techniques.
  
  
  METHODS
  A total of 128 consecutive patients who underwent closure of loop ileostomy between January 2002 and December 2008 were analyzed retrospectively. The primary outcome parameter was operative cost.
  
  
  RESULTS
  Closure of ileostomy was performed in 66 patients with hand-sewn anastomosis, in 25 patients with stapler only, and in 37 patients with a combination of stapler and suture. There were no differences in terms of early and late postoperative complications. Operative time was significantly longer for "suture only" (101.4 ± 26 min) than for "stapler/suture" (-4.9 min) and "stapler only" (-17.8 min); the difference between the three groups is significant (p = 0.05). Duration of hospital stay was not different among the three groups. Operative costs with "stapler/suture" (1,755.9 ± 355.6 EUR) were significantly higher than with "suture only" (-254 EUR; p = 0.001) and "stapler only" (-236 EUR; p = 0.005).
  
  
  CONCLUSIONS
  Operative time using the stapler only is significantly shorter than with hand-sewn anastomosis or combinations of stapler and suture. Operative costs are significantly higher for a procedure that includes suture and stapler.
authors.affiliation: Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
authors.forename: Karoline
authors.initials: K
authors.lastname: Horisberger
authors.forename: Guido
authors.initials: G
authors.lastname: Beldi
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D017792:Surgical Stapling / Q000191:economics; D013536:Suture Techniques / Q000191:economics*; D016896:Treatment Outcome