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Endoloop Versus LigaSure for Appendiceal Stump Closure in Pediatric Laparoscopic Appendectomy: A Multicenter
Şenay Kurtuluş1, Alev Süzen2, Neslihan Kaya Terzi3
1Department of Pediatric Surgery, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey.
Insights
LigaSure™ and Endoloop are safe and effective for pediatric laparoscopic appendectomy stump closure. Neither method resulted in stump leakage or abscesses, showing comparable outcomes in pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Technology
Background:
- Appendiceal stump closure is crucial in laparoscopic appendectomy (LA) to prevent post-operative complications.
- Evaluating novel devices like LigaSure™ against traditional methods like Endoloop is essential for optimizing pediatric LA outcomes.
Purpose of the Study:
- To compare the safety and effectiveness of LigaSure™ versus Endoloop for appendiceal stump closure in pediatric laparoscopic appendectomy.
Main Methods:
- A prospective, multicenter study involving 199 pediatric patients undergoing LA.
- Patients were divided into LigaSure™ (n=74) and Endoloop (n=125) groups based on surgeon preference.
- Data included demographics, complications, and histopathological measurements; analyzed using t-test and chi-square test (P < .05 significance).
Main Results:
- No significant differences in age, gender, leukocyte count, or C-reactive protein levels between groups.
- No intra-abdominal abscesses or stump leakage reported in either group; mean hospital stay was comparable (2 days).
- Complicated appendicitis was more frequent in the LigaSure™ group (12.2%) versus Endoloop (5.6%), with no increased adverse events.
Conclusions:
- LigaSure™ is a safe and effective alternative for appendiceal stump closure in pediatric LA.
- The device provides a secure seal, proving reliable even in cases of complicated appendicitis.
Abstract:
Background: Appendiceal stump closure is critical in laparoscopic appendectomy (LA) to prevent complications such as stump leakage and intra-abdominal abscess formation. This study aims to evaluate the safety and effectiveness of LigaSure™ versus Endoloop for appendiceal stump closure in pediatric LA. Methods: This prospective multicenter comparative study included 199 pediatric patients who underwent LA between May 2021 and October 2023 at two pediatric surgery clinics. Patients were allocated to the LigaSure group (n = 74) or Endoloop group (n = 125) based on the surgeon's intraoperative preference. Data collected included demographic characteristics, laboratory and radiological findings, intraoperative details, postoperative complications, and histopathological measurements of appendiceal and lumen diameters. Statistical analyses were performed using the independent samples t-test and chi-square test, with significance at P < .05. Results: No significant differences were observed between groups regarding age (P = .670), gender (P = .439), leukocyte count (P = .072), or C-reactive protein levels (P = .368). Complicated appendicitis was more prevalent in the LigaSure group (12.2%) compared to the Endoloop group (5.6%). No intra-abdominal abscesses or stump leakage were reported in either group. Histopathological analysis revealed no significant difference in mean appendiceal diameter (LigaSure: 8.9 ± 0.2 mm; Endoloop: 8.9 ± 0.1 mm; P = .743) or lumen diameter (P = .096). The largest lumen diameter measured in appendix specimens was 5113 μm, while the smallest was 255.6 μm (P = .096). No cases of intra-abdominal abscess or stump leakage were reported. The mean hospital stay was comparable (LigaSure: 2 ± 0.2 days; Endoloop: 2 ± 0.1 days; P = .068). Conclusion: LigaSure™ is a safe and effective alternative to Endoloop for appendiceal stump closure in pediatric LA. The device's ability to provide a secure seal makes it a reliable option, even in cases of complicated appendicitis.
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