Stump closure in laparoscopic appendectomy. Influence of endoloop or linear stapler on patient outcome]

Background. Even though laparoscopic appendectomy is one of the most frequent procedures in abdominal surgery, the technique of appendiceal stump closure is still not standardized. The aim of this retrospective study was to analyze the effect of the use of endoloops or linear staplers for appendiceal stump closure concerning surgical site infections (SSI) and intra-abdominal abscesses (IAA). Patients and methods. All laparoscopic appendectomies between January 1st 2007 and May 31st 2010 were split into an endoloop group (ELG) and a linear stapler group (LSG). The groups were compared with respect to the outcome parameters SSI and IAA. Results. A total of 430 appendectomies were performed in the study period of which 105 operations were conducted laparoscopically. In this study 47.6% (n=50) were alloted to the LSG and 52.4% (n=55) to ELG. In LSG 3.1% (n=1) developed an SSI versus 10.0% (n=4, p=0.254) in ELG. No IAAs occurred in LSG compared to 2 (5.1%, p=0.499) in ELG. Conclusion. The use of EL for appendiceal stump closure is safe and cost effective for low-grade appendicitis but high-grade appendicitis should be treated with LS.