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Appendiceal stump closure in laparoscopic appendectomy: one endoloop vs. two endoloops vs. two endoclips—does it matter?

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Abstract

Purpose

Appendiceal stump leak rate after laparoscopic appendectomy is extremely low. Various methods are used to close the appendiceal stump. This study aimed to compare the outcome of three appendiceal stump closure methods.

Methods

A retrospective study comparing stump closure methods and postoperative outcomes was conducted from January 2018 to June 2020. Patient data included demographics, pre-operative data, surgical technique, findings, and postoperative complications.

Results

Out of 1021 appendectomy patients, 733 underwent laparoscopic appendectomy for acute appendicitis utilizing one of the three compared appendiceal stump closure methods. Consequently, 360 appendixes were ligated with one endoloop (1EL group), 300 appendixes had two endoloops (2EL group), and 73 appendixes were ligated with two endoclips (2EC group). All groups used a LigaSure for resection. The rate of postoperative intra-abdominal abscess was 1% (4 patients) in 1EL group vs. 1% (3 patients) in 2EL group vs. none in 2EC group (p = 0.43). There were no reported appendiceal stump leaks. Overall complication rates were 4% (14 patients), 3% (9 patients), and 0 (p = 0.15), and the mean operative length was 43 ± 21, 54 ± 22, and 43 ± 20 mins for the 1EL, 2EL, and 2EC, respectively (p < 0.01). Average cost of one endoloop is 110$, and one endoclip cartridge is 180$.

Conclusions

None of the methods were found clinically superior over the others. Considering the low and mild complication rate, it appears reasonable to prefer one method simply by cost. The use of a single endoloop may result in substantial cost reduction. Medical centers may advise surgeons to use a single-endoloop technique.

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Authors and Affiliations

  1. Department of Surgery, Meir Medical Center, Affiliated with the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Rudnicki Yaron, Soback Hagai, Tibi Nayyera, Gutwetter Nili, Ken-Dror Shai & Avital Shmuel

Authors
  1. Rudnicki Yaron
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  2. Soback Hagai
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  3. Tibi Nayyera
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  4. Gutwetter Nili
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  5. Ken-Dror Shai
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  6. Avital Shmuel
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Contributions

Y.R., H.S., and S.A wrote the main manuscript. N.T., N.G, and S.K.D prepared the data and tables. All authors reviewed the manuscript.

Corresponding author

Correspondence to Rudnicki Yaron.

Ethics declarations

Ethics approval

This study was approved by the appropriate institutional research committee (approval no. MMC-192-20) and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. ClinicalTrials.gov (ID-NCT04886830).

Consent to participate

Formal consent is not required for this type of study (retrospective in nature). An exemption from informed consent for this study was given by the institutional research committee as the data were retrospectively retrieved from an existing prospectively and routinely collected database.

Conflict of interest

The authors declare no competing interests.

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Yaron, R., Hagai, S., Nayyera, T. et al. Appendiceal stump closure in laparoscopic appendectomy: one endoloop vs. two endoloops vs. two endoclips—does it matter?. Langenbecks Arch Surg 408, 270 (2023). https://doi.org/10.1007/s00423-023-03012-1

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