Endoloop as the First Line Tool for Appendiceal Stump Closure in Children with Appendicitis

Abstract

Purpose The objective of this study is to compare outcomes for pediatric patients undergoing laparoscopic appendectomy (LA) performed either (1) using an endostapler (ES) to divide the appendix and mesoappendix or (2) using endoloops (ELs) to close the appendiceal stump and electrocautery to divide the mesoappendix.

Methods We conducted a retrospective chart review of all patients who underwent LA for suspected appendicitis 4 years at a free standing children's hospital. The use of EL and ES was compared separately in patients with perforated and nonperforated appendicitis. We compared patient characteristics and outcomes.

Results There were no significant differences in rate of postoperative abscess, rate of subsequent small bowel obstruction requiring operation or rate of intraperitoneal hematoma between the ES and EL groups for both nonperforated and perforated appendectomy cases. Superficial wound infection was more common in the nonperforated EL group (17/309, 5.5%) than in the nonperforated ES group (2/235, 0.9%; p = 0.007). Operative time for the EL technique (52.2 ± 15.8 minutes; p = 0.047) was shorter than for the ES technique (58 ± 23.2 minutes) for patients with perforated appendicitis.

Conclusion EL stump closure and mesoappendix cauterization during LA is safe and effective in children with appendicitis, including perforated appendicitis.

Keywords

endoloop - appendicitis - perforated - nonperforated

• References

• 1 Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990; 132 (5) 910-925
• 2 Ponsky TA, Huang ZJ, Kittle K , et al. Hospital- and patient-level characteristics and the risk of appendiceal rupture and negative appendectomy in children. JAMA 2004; 292 (16) 1977-1982
• 3 Safavi A, Langer M, Skarsgard ED. Endoloop versus endostapler closure of the appendiceal stump in pediatric laparoscopic appendectomy. Can J Surg 2012; 55 (1) 37-40
• 4 Shalaby R, Arnos A, Desoky A, Samaha AH. Laparoscopic appendectomy in children: evaluation of different techniques. Surg Laparosc Endosc Percutan Tech 2001; 11 (1) 22-27
• 5 Lee SL, Stark R, Yaghoubian A, Shekherdimian S, Kaji A. Does age affect the outcomes and management of pediatric appendicitis?. J Pediatr Surg 2011; 46 (12) 2342-2345
• 6 Lee SL, Yaghoubian A, de Virgilio C. A multi-institutional comparison of pediatric appendicitis outcomes between teaching and nonteaching hospitals. J Surg Educ 2011; 68 (1) 6-9
• 7 Nataraja RM, Bandi A, Clarke SA, Haddad MJ. Comparison of intra-abdominal abscess formation following laparoscopic and open appendicectomy in children. J Laparoendosc Adv Surg Tech A 2010; 20 (4) 391-394
• 8 Wu HS, Lai HW, Kuo SJ , et al. Competitive edge of laparoscopic appendectomy versus open appendectomy: a subgroup comparison analysis. J Laparoendosc Adv Surg Tech A 2011; 21 (3) 197-202
• 9 Beldi G, Vorburger SA, Bruegger LE, Kocher T, Inderbitzin D, Candinas D. Analysis of stapling versus endoloops in appendiceal stump closure. Br J Surg 2006; 93 (11) 1390-1393
• 10 Lukish J, Powell D, Morrow S, Cruess D, Guzzetta P. Laparoscopic appendectomy in children: use of the endoloop vs the endostapler. Arch Surg 2007; 142 (1) 58-61 , discussion 62
• 11 Ponsky TA, Rothenberg SS. Division of the mesoappendix with electrocautery in children is safe, effective, and cost-efficient. J Laparoendosc Adv Surg Tech A 2009; 19 (Suppl. 01) S11-S13