Looped suture versus stapler device in pediatric laparoscopic appendectomy: a comparative outcomes and intraoperative cost analysis

Parikh, Punam P.; Tashiro, Jun; Wagenaar, Amy E.; Curbelo, Miosotys; Pérez, Eduardo A.; Neville, Holly L.; Hogan, Anthony R.; Sola, Juan E.

doi:10.1016/j.jpedsurg.2017.05.016

Cited by 17 publications

(11 citation statements)

References 13 publications

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“…Of those, 1082 records were excluded after screening for inappropriate article type; only randomized control trials and review articles were included, and those reporting key outcomes; 675 full text articles were then assessed for eligibility and 598 were excluded due to data being either inadequate for data interpretation, relating to interval appendectomy or duplication of studies. 77 were found to meet the inclusion criteria, and 45 of these were included for analysis after applying the MINORS score cut off . The modified PRISMA flowchart for identification and inclusion of relevant papers is included as Appendix S1.…”

Section: Resultsmentioning

confidence: 99%

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Bailey

Choynowski

Kabir

et al. 2019

ANZ Journal of Surgery

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Background Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. While many studies report readmission, a meta‐analysis of readmission post‐appendectomy has not been published. This meta‐analysis was undertaken to determine rates and predictors of hospital readmission following appendectomy and to potentially provide a metric benchmark. Methods An ethically approved PROSPERO‐registered (ID CRD42017069040) meta‐analysis following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, using databases PubMed and Scopus, was undertaken for studies published between January 2012 and June 2017. Articles relating to outcomes and readmissions after appendectomy were identified. Those scoring >15 for comparative studies and >10 for non‐comparative studies, using Methodological Index for Non‐Randomized Studies criteria were included in the final analysis. The odds ratios (OR) using random‐effects, Mantel–Haenszel method with 95% confidence intervals (CI), were computed for each risk factor with RevMan5. Results A total of 1757 articles reviewed were reduced to 45 qualifying studies for a final analysis of 836 921 appendectomies. 4.3% (range 0.0–14.4%) of patients were readmitted within 30 days. Significant preoperative patient factors for increased readmission were diabetes mellitus (OR 1.93, CI 1.63–2.28, P < 0.00001), complicated appendicitis (OR 3.6, CI 2.43–5.34, P < 0.00001) and open surgical technique (OR 1.39, CI 1.08–1.79, P < 0.00001). Increased readmission was not associated with gender, obesity or paediatric versus general surgeons or centres. Conclusion This meta‐analysis identified that readmission is not uncommon post‐appendectomy, occurring in one in 25 cases. The mean readmission rate of 4.3% may act as a quality benchmark for improving emergency surgical care. Targeting high‐risk groups with diabetes or complicated appendicitis and increasing use of laparoscopic technique may help reduce readmission rates.

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Section: Resultsmentioning

confidence: 99%

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Bailey

Choynowski

Kabir

et al. 2019

ANZ Journal of Surgery

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“…Some studies have examined the cost effectiveness of these two methods in pediatric patients undergoing laparoscopic appendectomy. [2][3][4] Other studies in adults undergoing laparoscopic appendectomy only refer to the price difference between the instruments themselves. 5,6 Studies that do analyze operative costs tend to be European.…”

mentioning

confidence: 99%

Cost Effectiveness of Different Methods of Appendiceal Stump Closure during Laparoscopic Appendectomy

Kim

Weireter

2018

The American Surgeon

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There is no standard method for closure of an appendiceal stump during laparoscopic appendectomy. This study compares stump closure using a stapler with closure using an Endoloop ligature. The charts of all patients who underwent laparoscopic appendectomy at a single tertiary care center over a two-year period were reviewed for demographics, comobidities, operative details and costs, and outcomes. There were 325 patients who underwent a laparoscopic appendectomy. The majority, 250 (77%), underwent stump closure with a stapler. They were equivalent in demographics and postoperative complication rates. Cases using an Endoloop were slightly faster in terms of procedure time and room time, and less expensive in terms of operative supply cost. The price difference is not explained by time saved in the operating room and more likely by the equipment price.

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“…Although LA in children has been considered as an effective and feasible procedure for the treatment of acute appendicitis, there are technical aspects regarding base closure that still need further analysis [4]. The most suitable method for stump closure is still under debate, and actually there is no consensus on one method [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…Advantages of LA over the conventional open appendectomy have been obviously declared in the last years. These advantages include lesser postoperative pain, shorter hospital stay, faster recovery and return to normal daily activities, and moreover there is a reduced liability to the onset of surgical site infections [4].…”

Section: Introductionmentioning

confidence: 99%

Hem-o-lok clip versus hand-made loop in base closure during laparoscopic appendectomy in children

Elgendy

Khirallah

2019

J Ped Endosc Surg

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Purpose To evaluate the efficacy and safety of hem-o-lok clip in base closure during laparoscopic appendectomy (LA) in children and compare its outcomes with handmade loop. Methods A prospective study was performed that included all patients who underwent LA at our hospital from January 2017 to March 2018. The cases were randomly divided into two groups according to the method used for base closure; in the first group double hem-o-lok clips were used, while double handmade loops were adopted in the second group. Data were collected and compared between groups by t and Chi-square tests including clinical data, operative time, complications, hospital stay and cost of supplies. Results The study included 44 patients, hem-o-lok clip group and handmade loop group consisted of 21 and 23 patients, respectively. There were no significant differences between both groups concerning patients' demographics, complications or hospital stay. Mean operative time was 29.95 ± 8.33 min in hem-o-lok clip group (range 18-47), whereas it was 38.78 ± 4.91 min in handmade loop group (range 31-52) reaching statistical significance (p = 0.001). In terms of costs, a cartridge of hem-o-lok clips to be used per each case costs approximately 14 USD in our country, while a single package of Vicryl ligature 2-0 for forming handmade loops costs 4 USD. Conclusions Hem-o-lok clip is effective and safe in securing the base of appendix during LA in children. Although it is slightly more expensive than handmade loop, it offers a significantly shorter operative time as the principal advantage when compared to handmade loop which is superior because of its economic value.

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Looped suture versus stapler device in pediatric laparoscopic appendectomy: a comparative outcomes and intraoperative cost analysis

Cited by 17 publications

References 13 publications

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Cost Effectiveness of Different Methods of Appendiceal Stump Closure during Laparoscopic Appendectomy

Hem-o-lok clip versus hand-made loop in base closure during laparoscopic appendectomy in children

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