title: Comparison of stapling techniques and management of the mesoappendix in laparoscopic appendectomy.
abstract: Many techniques for laparoscopic appendectomy have been proposed with few comparative studies. We performed a retrospective review of all patients undergoing laparoscopic appendectomy for uncomplicated appendicitis from 2006 to 2011. Techniques were: (1) transection of the mesoappendix and appendix with a single staple line (SSL); (2) transection of the mesoappendix and appendix with multiple staple lines (MSL); and (3) transection of the mesoappendix with ultrasonic shears and the appendix with a single staple line (USSL). A total of 565 cases were reviewed (149 SSL, 259 MSL, and 157 USSL). Patients treated with the SSL technique had decreased operative duration (P<0.001) and length of stay (P=0.003) despite equivalent disease presentations. Multivariate analysis demonstrated decreased operative duration with the SSL technique (P=0.001). Use of a SSL for transection of the mesoappendix and appendix is both a safe and efficient technique that results in reduced operative duration with excellent surgical outcomes.
authors.affiliation: Grand Rapids Medical Education Partners General Surgery Residency Program Michigan State University College of Human Medicine Spectrum Health Medical Group, Department of Surgical Specialties, Grand Rapids, MI.
authors.forename: G Paul
authors.initials: GP
authors.lastname: Wright
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Mitchell
authors.forename: Amanda M
authors.initials: AM
authors.lastname: McClure
authors.forename: Jill K
authors.initials: JK
authors.lastname: Onesti
authors.forename: Steven C
authors.initials: SC
authors.lastname: Moyo
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Brown
authors.forename: Andi
authors.initials: A
authors.lastname: Peshkepija
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Scott
authors.forename: Mathew H
authors.initials: MH
authors.lastname: Chung
mesh_terms: D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Vons C, Barry C, Maitre S, et al.. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label non-inferiority, randomised controlled trial. Lancet. 2011;377:1573–1579.
references.citation: Hansson J, Korner U, Khorram-Manesh A, et al.. Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg. 2009;96:473–481.
references.citation: Daniell JF, Gurley LD, Kurtz BR, et al.. The use of an automatic stapling device for laparoscopic appendectomy. Obstet Gynecol. 1991;78:721–723.
references.citation: Sajid MS, Rimple J, Cheek E, et al.. Use of Endo-GIA versus Endo-loop for securing the appendicular stump in laparoscopic appendicectomy: a systematic review. Surg Laparosc Endosc Percutan Tech. 2009;19:11–15.
references.citation: Klaiber C, Wagner M, Metzger A. Various stapling techniques in laparoscopic appendectomy: 40 consecutive cases. Surg Laparosc Endosc. 1994;4:205–209.
references.citation: Olguner M, Akgur FM, Ucan B, et al.. Laparoscopic appendectomy in children performed using single endoscopic GIA stapler for both mesoappendix and base of appendix. J Pediatr Surg. 1998;33:1347–1349.
references.citation: Yauger BJ, Dunlow SG, Lockrow EG. Laparoscopic appendectomy: a series of cases utilizing laparosonic coagulating shears as compared to Endo-GIA and Endoshears. J Reprod Med. 2005;50:231–234.
references.citation: Yang HR, Wang YC, Chung PK, et al.. Laparoscopic appendectomy using the LigaSure vessel sealing system. J Laparoendosc Adv Surg Tech A. 2005;15:353–356.
references.citation: Sucullu I, Filiz AI, Kurt Y, et al.. The effects of LigaSure on the laparoscopic management of acute appendicitis: “LigaSure assisted laparoscopic appendectomy”. Surg Laparosc Endosc Percutan Tech. 2009;19:333–335.
references.citation: Schilling PL, Dimick JB, Birkmeyer JD. Prioritizing quality improvement in general surgery. J Am Coll Surg. 2008;207:698–704.
references.citation: Tucker JG, Copher JC, Reilly JP, et al.. The use of bioabsorbable seamguard during laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech. 2007;17:83–85.
references.citation: Korndorffer JR Jr, Fellinger E, Reed W. SAGES guideline for laparoscopic appendectomy. Surg Endosc. 2010;24:757–761.
references.citation: Sporn E, Petroski GF, Mancini GJ, et al.. Laparoscopic appendectomy—is it worth the cost? Trend analysis in the US from 2000 to 2005. J Am Coll Surg. 2009;208:179–185.
references.citation: Masoomi H, Nguyen NT, Dolich MO, et al.. Comparison of laparoscopic versus open appendectomy for acute nonperforated and perforated appendicitis in the obese population. Am J Surg. 2011;202:733–739.
references.citation: Mason RJ, Moazzez A, Moroney JR, et al.. Laparoscopic vs open appendectomy in obese patients: outcomes using the American College of Surgeons National Surgical Quality Improvement Program Database. J Am Coll Surg. 2012;215:88–100.