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Use of the Endoloop vs the Endostapler

Jeffrey Lukish, MD; David Powell, MD; Steve Morrow, MD; David Cruess, PhD; Phil Guzzetta, MD

Arch Surg. 2007;142(1):58-61.

Hypothesis  Two techniques are used for laparoscopic appendectomy (LA): division of the mesoappendix with the harmonic scalpel and ligation of the appendix with an endoloop (EL), or division of the mesoappendix and appendix with an endostapler (ES). Using an ES is a cost-effective technique that provides an outcome benefit in children who require appendectomy.

Design  Case series.

Setting  Academic, tertiary care children's hospital.

Patients  Seventy-five children who underwent LA from January 1, 2002, to March 31, 2004.

Intervention  Laparoscopic appendectomy.

Main Outcome Measures  Age, diagnosis, length of stay, surgical time, total operating room time, complications, and instrumentation costs were compared between the EL and ES groups.

Results  There was no significant difference in age, length of stay, perforated, gangrenous, or acute appendicitis diagnoses, or complications between the groups. The surgical time and total operating room time for LA in children in the ES group were significantly shorter than in children in the EL group by 15% and 17%, respectively (P<.05). The disposable equipment costs for LA were $201 per case in the ES group vs $400 per case in the EL group. The mean 14.9-minute increase in total operating room time in children in the EL group resulted in $373 of additional operating room and anesthesia costs. The decreased disposable equipment costs and shorter surgical time of LA in the ES group led to cost savings of $572 per case as compared with children who underwent LA with an EL.

Conclusions  There is no significant difference in outcome between children who undergo LA with an EL or with an ES. However, this study supports the use of the ES for LA as a more cost-effective technique that is associated with reduced surgical time.

Author Affiliations: Walter Reed Army Medical Center (Dr Lukish), and Department of Pediatric Surgery, Children's National Medical Center (Drs Lukish, Powell, and Guzzetta), Washington, DC; National Naval Medical Center (Dr Lukish), and Divisions of Pediatric Surgery (Dr Lukish) and Biostatistics (Drs Lukish and Cruess), Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Md; and Department of Pediatric Surgery, Vanderbilt Children's Hospital, Nashville, Tenn (Drs Lukish and Morrow).

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