title: Appendiceal stump closure in children with complicated appendicitis: a prospective analysis of endoloops versus endostaples.
abstract: BACKGROUND
  Laparoscopic appendectomy (LA) can be performed safely and effectively using endoloops (EL) or endostaples (ES). We compared EL and ES for stump closure during LA for complicated appendicitis in children.
  
  
  METHODS
  All LA for complicated appendicitis performed between July 2005 and August 2009 were assessed prospectively. EL were used in 37 procedures and ES in 31. Apart from choice of technique which was the personal preference of the attending surgeon, all patients were managed according to the same intraoperative and postoperative protocols.
  
  
  RESULTS
  There was no significant difference between mean age at operation; gender ratio; mean preoperative and postoperative white blood cell; mean preoperative and postoperative white blood cell C-reactive protein; histopathology; mean operating time (EL: 71 minutes; ES: 64 minutes); mean hospitalization (EL: 5.3 days; ES: 5.1 days); febrile period (EL: 2.1 days; ES: 1.9 days); white blood cell normalization (EL: 2.6 days; ES: 2.4 days); and intravenous antibiotic usage (EL: 3.8 days; ES: 3.7 days). There were no intraoperative complications or ICU admissions in either group, but two EL cases required conversion to open surgery (P=NS). Incidences of intra-abdominal abscess (EL: n=1 or 2.7%; ES: n=1 or 3.2%), transient ileus (EL: n=2 or 5.4%; ES: n=2 or 6.4%), small bowel obstruction (EL: n=0; ES: n=0), and wound infection (EL: n=1 or 2.7%; ES: n=1 or 3.2 %) were not significantly different. Rate of rehospitalization for EL was 2.7% (n=1; colitis), and for ES, it was 3.2% (n=1; intra-abdominal abscess) (P=NS). Mean cost for EL was US$890, and for ES, it was US$1300.
  
  
  CONCLUSIONS
  This is the first prospective study comparing EL and ES during LA for complicated appendicitis in children. ES is more expensive, but there was no significant difference in morbidity for this technique, particularly with regard to incidence of postoperative intra-abdominal abscess.
authors: Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan. go1993@hotmail.co.jp
authors: G
authors: G
authors: Miyano
authors: M
authors: M
authors: Urao
authors: Gj
authors: G
authors: Lane
authors: Y
authors: Y
authors: Kato
authors: T
authors: T
authors: Okazaki
authors: A
authors: A
authors: Yamataka
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D001064:Appendicitis / Q000191:economics / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000191:economics; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013536:Suture Techniques / Q000191:economics / Q000295:instrumentation; D013537:Sutures; D016896:Treatment Outcome; D055815:Young Adult