title: A prospective analysis of endoloops and endostaples for closing the stump of the appendix in children.
abstract: OBJECTIVE
  The aim of this study was to compare endoloops and endostaples for closing the stump of the appendix during laparoscopic appendectomy (LA) for uncomplicated appendicitis in children.
  
  
  METHODS
  All LA performed for appendicitis from 2005 to 2009 were analyzed prospectively. Cases of complicated appendicitis such as perforated appendicitis or intra-abdominal abscess were excluded, leaving 75 cases closed with loops and 81 cases closed with staples. Choice of technique was determined by the attending surgeon's preference. All patients were managed according to the same pre-, intra-, and postoperative protocols.
  
  
  RESULTS
  There were no significant differences between mean age at surgery, gender ratio, preoperative mean white blood cell count and mean C-reactive protein, histopathologic findings, mean duration of surgery, and mean hospitalization. There were no intra-operative complications in either group, but one loop case required conversion to open surgery (P = NS). There were no significant differences in the incidences of intra-abdominal abscess, transient ileus, small bowel obstruction, and wound infection. The postoperative readmission rate for management of complications was 4.0% for loop cases and 2.5% for staple cases (P = NS). Overall, using staples for a standard LA (anesthesia and stump closure) was U.S. $405 more expensive than when loops were used.
  
  
  CONCLUSIONS
  This is the first prospective study comparing endoloops with endostaples for closing the stump of the appendix during LA for uncomplicated appendicitis in children. Although stapling proved to be more expensive, the choice of technique should reflect the surgeon's experience and confidence to ensure that the patient has the safest possible LA.
authors.affiliation: Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan. go1993@hotmail.co.jp
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.forename: Masahiko
authors.initials: M
authors.lastname: Urao
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kato
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okazaki
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000191:economics; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D013536:Suture Techniques / Q000191:economics; D013537:Sutures / Q000191:economics; D016896:Treatment Outcome