P. P. Parikh1, J. Tashiro1, A. E. Wagenaar1, M. Curbelo2, N. Joudi1, E. A. Perez1, H. L. Neville1, A. R. Hogan1, J. E. Sola1 1University Of Miami,Surgery,Miami, FL, USA 2Baptist Children’s Hospital,Surgery,Miami, FL, USA
Introduction: The appendix may be ligated using several methods in laparoscopic appendectomy (LA). There exists controversy regarding the use of looped suture or stapler devices. We sought to compare outcomes between LA performed by two surgeons using looped suture or stapler devices, exclusively.
Methods: Cases performed by two experienced pediatric surgeons were compared for fiscal years 2013 and 2014. One surgeon used looped suture exclusively, the other used staplers exclusively. Chi-square tests were performed to analyze associations.
Results: A total of 238 cases were analyzed, with 128 LA performed by stapler (54%) and 110 performed by looped suture (46%). Operating room costs were $707.12 for stapler LA and $317.10 for looped suture LA. The only significant differences in costs were those associated with ligation type. Acute appendicitis was diagnosed in 75% of cases, with the remainder being perforated or gangrenous (25%). Mean patient age was 12.1 ± 3.7 years. Patients were 58% male, 42% female. Children were most frequently of Hispanic (76%), followed by Caucasian (13%) and African American (6%) descent. Transferred patients comprised 62% of patients at the facility. CT scans were ordered in 16% of cases. Antibiotics were prescribed upon discharge for a small number of individuals (29%). Complications occurred during the admission in 3 cases. Complications occurred within 30 days of LA in 12 cases.
On bivariate analysis, length of stay and rates of in-hospital or 30-day complications, return to ER, readmissions within 30 days did not significantly differ between the two ligation methods.
Conclusion: On comparison of looped suture and stapler devices for laparoscopic appendectomy, complications, readmissions, ER visits, and length of stay were not significantly different. Although outcomes were unaffected by ligation type, significant cost savings ($390/case) are achievable with looped suture LA.