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

Schürmann, Olaf; Mehdorn, H. Maximilian; Gockel, Ines

doi:10.1186/s12893-017-0277-z

Cited by 13 publications

(15 citation statements)

References 25 publications

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“…Relatedly, the incidence of postoperative complications is a key quality metric for evaluating surgeon and hospital performance [28][29][30][31][32][33][34][35]. In over 4000 consecutive patients with acute appendicitis, the overall 90-day incidence of postoperative complications following appendectomy was 12.6%.…”

Section: Discussionmentioning

confidence: 99%

Techniques for mesoappendix transection and appendix resection: insights from the ESTES SnapAppy study

Bass

Kaplan

Forssten

et al. 2023

Eur J Trauma Emerg Surg

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Introduction Surgically managed appendicitis exhibits great heterogeneity in techniques for mesoappendix transection and appendix amputation from its base. It is unclear whether a particular surgical technique provides outcome benefit or reduces complications. Material and methods We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during SnapAppy (ClinicalTrials.gov Registration: NCT04365491). We collected routine, anonymized observational data regarding surgical technique, patient demographics and indices of disease severity, without change to clinical care pathway or usual surgeon preference. Outcome measures of interest were the incidence of complications, unplanned reoperation, readmission, admission to the ICU, death, hospital length of stay, and procedure duration. We used Poisson regression models with robust standard errors to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). Results Three-thousand seven hundred sixty-eight consecutive adult patients, included from 71 centers in 14 countries, were followed up from date of admission for 90 days. The mesoappendix was divided hemostatically using electrocautery in 1564(69.4%) and an energy device in 688(30.5%). The appendix was amputated by division of its base between looped ligatures in 1379(37.0%), with a stapler in 1421(38.1%) and between clips in 929(24.9%). The technique for securely dividing the appendix at its base in acutely inflamed (AAST Grade 1) appendicitis was equally divided between division between looped ligatures, clips and stapled transection. However, the technique used differed in complicated appendicitis (AAST Grade 2 +) compared with uncomplicated (Grade 1), with a shift toward transection of the appendix base by stapler (58% vs. 38%; p < 0.001). While no statistical difference in outcomes could be detected between different techniques for division of appendix base, decreased risk of any [adjusted IRR (95% CI): 0.58 (0.41–0.82), p = 0.002] and severe [adjusted IRR (95% CI): 0.33 (0.11–0.96), p = 0.045] complications could be detected when using energy devices. Conclusions Safe mesoappendix transection and appendix resection are accomplished using heterogeneous techniques. Technique selection for both mesoappendix transection and appendix resection correlates with AAST grade. Higher grade led to more ultrasonic tissue transection and stapled appendix resection. Higher AAST appendicitis grade also correlated with infection-related complication occurrence. Despite the overall well-tolerated heterogeneity of approaches to acute appendicitis, increasing disease acuity or complexity appears to encourage homogeneity of intraoperative surgical technique toward advanced adjuncts.

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Section: Discussionmentioning

confidence: 99%

Techniques for mesoappendix transection and appendix resection: insights from the ESTES SnapAppy study

Bass

Kaplan

Forssten

et al. 2023

Eur J Trauma Emerg Surg

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“…It has been demonstrated that LA is performed more frequently in high-income countries in comparison to low-income countries (67.7% vs 8.1%), with better postoperative outcomes[ 54 ]. The difference in the costs of the used surgical devices (above all stapler) represented a principal determinant for the overall economic impact of the surgical procedure in some recent reports[ 33 , 36 , 38 , 50 , 51 ], to highlight how important is the cost-effectiveness in the measured outcomes. The medium saving reported in the present paper is relevant, varying from around approximately 300 € to more than 500 € just for the device, which then must be multiplied for the many LA conducted worldwide; further cost-analysis including operative time and LOS could reach major savings.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, it is still debated the use of endostapler (ES) vs endoloop (EL) in appendiceal stump closure[ 25 - 28 ]. The routine use of EL is safe in most patients affected by AA, also when it is complicated[ 29 - 32 ], representing a cost-effective device when taking into consideration the additional costs of potential post-operative complications, too[ 33 - 37 ]. We have previously shown money saving as well as the safety of the routine use of ELs[ 38 ].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis

Zorzetti¹,

Lauro²,

Bellini³

et al. 2022

World J Gastrointest Surg

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BACKGROUND Acute appendicitis (AA) is one of the main indications for urgent surgery. Laparoscopic appendectomy (LA) has shown advantages in terms of clinical results and cost-effectiveness, even if there is still controversy about different devices to utilize, especially with regards to the endoloop (EL) vs endostapler (ES) when it comes to stump closure. AIM To compare safety and cost-effectiveness of EL vs ES. METHODS From a prospectively maintained database, data of 996 consecutive patients treated by LA with a 3 years-follow up in the department of Emergency General Surgery - St Orsola University Hospital, Bologna (Italy) were retrieved. A meta-analysis was performed in terms of surgical complications, in comparison to the international literature published from 1995 to 2021. RESULTS The meta-analysis showed no evidence regarding wound infections, abdominal abscesses, and total post-operative complications, in terms of superiority of a surgical technique for the stump closure in LA. CONCLUSION Even when AA is complicated, the routine use of EL is safe in most patients.

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“…Miyano et al 13 refer that, in the USA, average operating cost using endoloop is USD $ 890, while using the stapler it is USD $ 1,300. Mehdorn et al 10 report that, in Germany, the use of the stapler is € 235 more expensive than the use of endoloop.…”

Section: Discussionmentioning

confidence: 99%

Comparison between endoloop and linear mechanical stapler for the appendicular stump closure

Granados-Romero¹,

Valderrama-Treveriño²,

Barrera-Mera³

et al. 2019

CIRUE

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Introduction:In the last decades, the approach by minimally invasive surgery of abdominal pathologies is growing due to its evident benefits; the appendicular cases being the main surgical emergency, with different methods of closing the appendicular base. In this article, we compared the appendicular base closure with linear stapler and endoloop, to analyze the frequency of complications such as abscess, dehiscence and seroma. Method: A prospective, observational and descriptive study was conducted, with a total of 703 procedures, using 567 endoloop patients and 136 linear stapler, operated by the same surgeon and surgical team, with a completed learning curve. Results: The complications referred in the present study were patients with abscess (n = 5), dehiscence (n = 3) and seroma (n = 3). According to the phases of the appendiceal pathology: phase 1 or congestive appendix did not present complications; phase 2 or suppurative was reported one case of surgical wound dehiscence in the use of endoloop; in phase 3 or necrotic, one case of seroma was reported in a patient treated with endoloop; while in phase 4 or perforated there is a significant difference in the case of abscesses, reporting five in the use of endoloop and none in the case of a linear stapler. Conclusions: In our study there is no statistically significant difference between the use of linear stapler or endoloop in the early appendicular phases; being of significant utility in Phase 4 the use of linear stapler for the incidence of abscesses.

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

Cited by 13 publications

References 25 publications

Techniques for mesoappendix transection and appendix resection: insights from the ESTES SnapAppy study

Techniques for mesoappendix transection and appendix resection: insights from the ESTES SnapAppy study

Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis

Comparison between endoloop and linear mechanical stapler for the appendicular stump closure

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