Zorzetti N, Lauro A, Bellini MI, Vaccari S, Dalla Via B, Cervellera M, Cirocchi R, Sorrenti S, D’Andrea V, Tonini V. Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis. World J Gastrointest Surg 2022; 14(9): 1060-1071 [PMID: 36185568 DOI: 10.4240/wjgs.v14.i9.1060]
Corresponding Author of This Article
Maria Irene Bellini, MD, PhD, Assistant Professor, Senior Lecturer, Department of Surgical Sciences, Sapienza University, Viale Regina Elena, Rome 00161, Italy. mariairene.bellini@uniroma1.it
Research Domain of This Article
Surgery
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2022; 14(9): 1060-1071 Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.1060
Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis
Noemi Zorzetti, Augusto Lauro, Maria Irene Bellini, Samuele Vaccari, Barbara Dalla Via, Maurizio Cervellera, Roberto Cirocchi, Salvatore Sorrenti, Vito D’Andrea, Valeria Tonini
Noemi Zorzetti, Department of General Surgery, Ospedale Civile A Costa, Porretta Terme 40046, Italy
Noemi Zorzetti, Augusto Lauro, Maria Irene Bellini, Samuele Vaccari, Salvatore Sorrenti, Vito D’Andrea, Department of Surgical Sciences, Sapienza University, Rome 00161, Italy
Samuele Vaccari, Department of General Surgery, Ospedale di Bentivoglio, Bologna 40010, Italy
Barbara Dalla Via, Valeria Tonini, Department of Emergency Surgery, St Orsola University Hospital, Bologna 40138, Italy
Maurizio Cervellera, Department of General Surgery, Ospedale Santissima Annunziata, Taranto 74121, Italy
Roberto Cirocchi, Department of General Surgery, Ospedale di Terni, Università di Perugia, Terni 05100, Italy
Author contributions: Zorzetti L and Bellini MI wrote and revised the article; Lauro A, Dalla Via B, Cervellera M, Tonini V, Sorrenti S, Cirocchi R and D’Andrea V designed the research study; Vaccari S, Zorzetti N, Lauro A, and Bellini MI performed the research; and all authors have read and approve the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maria Irene Bellini, MD, PhD, Assistant Professor, Senior Lecturer, Department of Surgical Sciences, Sapienza University, Viale Regina Elena, Rome 00161, Italy. mariairene.bellini@uniroma1.it
Received: April 21, 2022 Peer-review started: April 21, 2022 First decision: July 14, 2022 Revised: July 22, 2022 Accepted: August 19, 2022 Article in press: August 19, 2022 Published online: September 27, 2022 Processing time: 153 Days and 18.4 Hours
Abstract
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.
Core Tip: Stump closure in the acute appendectomy setting could be performed via endoloop (EL) or endostapler use. The present meta-analysis assesses the experience of 996 patients consecutively treated in the department of Emergency General Surgery - St Orsola University Hospital, Bologna (Italy) and the evidence published in literature, confirming there is no superiority of a surgical method on how to perform the stump closure, with regards to wound infections, abdominal abscess, and total post-operative complications. Even when acute appendicitis is complicated, the routine use of EL is safe in most patients.
