Analysis of endoloops and endostaples for closing the appendiceal stump during laparoscopic appendectomy

Rakić, Mislav; Jukić, Miro; Pogorelić, Zenon; Mrklić, Ivana; Kliček, Robert; Družijanić, Nikica; Perko, Zdravko; Patrlj, Leonardo

doi:10.1007/s00595-013-0818-8

Cited by 49 publications

(52 citation statements)

References 20 publications

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“…Less pain, lower rates of wound infection and shorter hospital stay, due to reduced surgical trauma, are advantages [19][20][21]. However, the safest endoscopic technique to close the appendiceal stump remains debateable [7,[22][23][24]. Intraabdominal abscesses are known to be the most common surgical complication following an endoscopic appendectomy procedure [4,25], and might be influenced directly by the closure technique as well as by the occurrence of perforation of the appendicitis.…”

Section: Discussionmentioning

confidence: 99%

Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses

Soll

Wyss

Gelpke

et al. 2016

Langenbecks Arch Surg

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Section: Discussionmentioning

confidence: 99%

Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses

Soll

Wyss

Gelpke

et al. 2016

Langenbecks Arch Surg

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“…No difference in overall LOS did occur after introduction of the endoloop in our cohort. In comparison to the literature, our patients had a shorter post-operative LOS [5, 21], which might be led by the DRG-system that expects a mean LOS of 4 days. Ultimately however the point of time for discharge is a clinical decision which requires decreasing inflammatory parameters, normal bowel function, bearable postoperative pain and regular wound healing.…”

Section: Discussionmentioning

confidence: 47%

Intended cost reduction in laparoscopic appendectomy by introducing the endoloop: a single center experience

Schürmann

Mehdorn²,

Gockel

2017

BMC Surg

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BackgroundCost reduction measures in medicine are gaining greater importance nowadays, especially in high-volume procedures such as laparoscopic appendectomy (LAE). Currently there are two common methods of dissecting the appendix from the caecal pole: linear stapler and endoloops. The endoloop is the cheaper device but can only be used in uncomplicated cases of appendicitis. Therefore both methods are used in LAE depending on intraoperative findings. The goal of this study was to retrospectively evaluate possible cost reduction due to increased use of endoloop in LAE in our general surgery department of a tertiary referral university hospital.MethodsWe previously used the stapler for appendix dissection in LAE as our local protocol but introduced the endoloop as standard method in 2015 to reduce intraoperative costs. We conducted a retrospective analysis of patients who underwent LAE between June 2014 and October 2015 in our department. Our purpose is to show the effects on cost reduction during the introductory period adjusting for a potential bias due to the individual learning curve of every surgeon. We estimated costs for LAE by taking into account average device costs and duration of operation (DO) as well as patient outcome.ResultsA total of 177 patients underwent LAE, 73 in 2014 (phase I) and 104 in 2015 (phase II). The median DO was 61 (± 24 SD) min during the entire period, and increased by 14 min from phase I to II (from 51 (±23 SD) min to 65 (±24 SD) min respectively, p < 0.001). The use of endoloops increased from 10% to 55% (p < 0.001). Patients’ characteristics and outcomes did not differ significantly. A median saving of 5.9€ per operation was calculated in phase II compared to phase I (p = 0.80).ConclusionIntroducing the endoloop as standard device for LAE leads to a marginal reduction in intraoperative costs without increasing negative outcomes. In our model the cost-reduction achieved by cheaper devices was overcome by increased costs for DO during the initial phase of use of endoloops. A longer follow up might show a more pronounced cost reduction.

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“…The most important stage of LA, maybe is stump closure, because, incomplete ligation may lead to serious complications such as intraabdominal infections, colonic fistula, postoperative peritonitis and even sepsis (13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

“…There are some methods for appendiceal stump closure, that all are safe, such as metallic clips (1,6,11,14,16,18,20,22), polymeric clips (Hem-o-lock) (4,8,10,14,18,22,23), endo loop (2,5,7,13,14,(16)(17)(18)(19)(21)(22)(23)(24)(25), endo stapler (5,8,11,13,(19)(20)(21)(22)24), intra corporeal knot (3,7,11,20,22) and bipolar and vessel sealing devices (15,22,26).…”

Section: Introductionmentioning

confidence: 99%

Use of Polymeric Clip (Hem-O-Lock) for Appendiceal Stump Ligation as a Favorable Technique in Laparoscopic Appendectomy

Kermansaravi

Darabi

Eghbali

et al. 2017

J Minim Invasive Surg Sci

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Background: Laparoscopic appendectomy (LA) has become the standard choice for acute appendicitis. Several techniques to close the appendiceal stump were investigated, and use of polymeric clips, are shown safe and cost effective. Objectives: Evaluation of the efficacy and safety of appendiceal stump closure with polymeric clips in LA. Methods: This is a retrospective cohort study included 35 patients who underwent LA, between April 2013 and August 2016 in Rasoole-Akram university hospital. appendiceal stumps ligation were performed by polymeric clips. One month follow up after surgery was performed for all patients. Demographic information of patinets, surgery, complications, readmission and pathological reports, were collected from medical records and data base. Results: Thirty-five patients were included in this retrospective study. Nineteen patients were male and 16 patients were female

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Analysis of endoloops and endostaples for closing the appendiceal stump during laparoscopic appendectomy

Cited by 49 publications

References 20 publications

Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses

Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses

Intended cost reduction in laparoscopic appendectomy by introducing the endoloop: a single center experience

Use of Polymeric Clip (Hem-O-Lock) for Appendiceal Stump Ligation as a Favorable Technique in Laparoscopic Appendectomy

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