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Endoloop versus endostapler closure of the appendiceal stump in pediatric laparoscopic appendectomy
Arash Safavi1, Monica Langer, Erik D Skarsgard
1Department of Surgery, BC Children's Hospital, Vancouver, BC.
Insights
For perforated appendicitis, endoloop stump closure in pediatric laparoscopic appendectomy is associated with lower intra-abdominal abscess rates compared to endostapler. This suggests endoloop may be a safer technique for perforated cases.
Area of Science:
- Pediatric Surgery
- Laparoscopic Surgery
- Gastrointestinal Surgery
Background:
- Limited data exists on optimal appendiceal stump control techniques in pediatric laparoscopic appendectomy (LA).
- Complications such as stump leak, intra-abdominal abscess (IAA), and surgical site infection (SSI) are critical outcomes.
- Comparison of stump control methods in perforated (PA) versus non-perforated appendicitis (NPA) is needed.
Purpose of the Study:
- To compare complication rates (IAA, SSI, stump leak) between endoloop (EL) and endostapler (ES) for appendiceal stump control in pediatric LA.
- To analyze these outcomes in patients with perforated appendicitis (PA) versus non-perforated appendicitis (NPA).
Main Methods:
- Retrospective review of pediatric LA cases (2006-2009).
- Stump closure technique (EL vs. ES) determined by surgeon preference.
- Logistic regression analysis explored interactions between stump closure and other factors (drains, irrigation, antibiotics).
Main Results:
- Of 242 patients, 57 had PA. EL was used in 82.5% of PA and 87% of NPA cases.
- In PA patients, IAA was significantly higher with ES (50%) vs. EL (12.7%) (OR 7.09, p=0.042).
- No significant differences in SSI rates were observed. No stump leaks occurred in either group.
Conclusions:
- Endoloop (EL) appears to be a safe and effective method for appendiceal stump control in most pediatric perforated appendicitis cases.
- Higher IAA rates with endostapler (ES) in PA may relate to stump quality rather than the closure technique itself.
- Further research into factors influencing stump quality and closure technique selection is warranted.
Background:
There is little information available to inform choice of technique for appendiceal stump control in pediatric laparoscopic appendectomy (LA). We compared complications (stump leak, intra-abdominal abscess formation [IAA], surgical site infection [SSI]) in children undergoing LA for perforated (PA) and nonperforated appendicitis (NPA) by technique of appendiceal stump control.
Methods:
All children who underwent LA for confirmed acute appendicitis between 2006 and 2009 were reviewed. Choice of stump control (endoloop [EL] or endostapler [ES]) was determined by surgeon preference. Interactions between stump closure techniques and other potential confounders (intra-abdominal drain, irrigation, different antibiotic regimens) were explored using a logistic regression model.
Results:
Of 242 patients undergoing LA, 57 (23.6%) had PA. In the PA group the appendiceal stump was closed with EL in 47 (82.5%) patients, while in the NPA group EL was used in 161 (87%) patients. Among PA patients, IAA was more common in the ES than the EL group (5 of 10 [50%] v. 6 of 47 [12.7%]). There was no significant difference in rates of SSI. Among NPA patients, there were no differences in rates of IAA or SSI. There were no stump leaks in either group. Logistic regression analysis confirmed the predictive effect of ES use on IAA formation in PA (adjusted odds ratio 7.09; 95% confidence interval 1.08-46.13; p = 0.042).
Conclusion:
Our data suggest that in most cases of PA, the appendiceal stump can be safely controlled with EL. Within the PA group, the higher rates of IAA seen in ES patients may be attributable to the quality of the appendiceal stump rather than the technique of closure.
