A systematic review on the cost evaluation of two different laparoscopic surgical techniques among 996 appendectomies from a single center.
Acute Disease
Appendectomy
/ economics
Appendicitis
/ economics
Cost Savings
/ economics
Cost-Benefit Analysis
Costs and Cost Analysis
Hospitals, University
/ economics
Italy
Laparoscopy
/ economics
Postoperative Complications
/ economics
Retrospective Studies
Surgical Staplers
/ economics
Wound Closure Techniques
/ economics
Acute appendicitis
Cost analysis
Endoloop
Laparoscopic appendectomy
Post-operative complications
Stapler
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
21
10
2019
accepted:
20
05
2020
pubmed:
1
6
2020
medline:
31
12
2020
entrez:
1
6
2020
Statut:
ppublish
Résumé
Acute appendicitis is one of the main indications for urgent surgery representing a high-volume procedure worldwide. The current spending review in Italy (and not only in this country) affects the health service and warrants care regarding the use of different surgical devices. The aim of our study is to perform a cost evaluation, comparing the use of endoloops and staplers in complicated acute appendicitis (phlegmonous and gangrenous), taking into consideration the cost of the device in relation to the management of any associated postoperative complications. We retrospectively evaluated 996 laparoscopic appendectomies of adult patients performed in the Emergency General Surgery-St. Orsola University Hospital in Bologna (Italy). Surgical procedures together with the related choice of using endoloops or staplers were performed by attending surgeons or resident surgeons supervised by a tutor. A systematic review was performed to compare our outcomes with those reported in the literature. In our experience, the routine use of endoloop leads to a real estimated saving of 375€ for each performed laparoscopic appendectomy, even considering post-operative complications. Comparing endoloop and stapler groups, the total number of complications is significantly lower in the endoloop group. Our systematic review confirmed these findings even if the superiority of one technique has not been proved yet. Our analysis shows that the routine use of endoloop is safe in most patients affected by acute appendicitis, even when complicated, and it is a cost-effective device even when taking into consideration extra costs for potential post-operative complications.
Identifiants
pubmed: 32474801
doi: 10.1007/s13304-020-00817-3
pii: 10.1007/s13304-020-00817-3
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1167-1174Références
Birnbaum BA, Wilson SR (2000) Appendicitis at the millennium. Radiology 215:337–348. https://doi.org/10.1148/radiology.215.2.r00ma24337
doi: 10.1148/radiology.215.2.r00ma24337
pubmed: 10796905
Costa-Navarro D, Jiménez-Fuertes M, Illán-Riquelme A (2013) Laparoscopic appendectomy: quality care and cost-effectiveness for today’s economy. World J Emerg Surg 8:45. https://doi.org/10.1186/1749-7922-8-45
doi: 10.1186/1749-7922-8-45
pubmed: 24180475
pmcid: 3842793
Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT, Stamos MJ (2011) Comparison of outcomes of laparoscopic versus open appendectomy in adults: data from the Nationwide Inpatient Sample (NIS), 2006–2008. J Gastrointest Surg 15:2226–2231. https://doi.org/10.1007/s11605-011-1613-8
doi: 10.1007/s11605-011-1613-8
pubmed: 21725700
Sajid MS, Rimple J, Cheek E, Baig MK (2009) Use of endo-GIA versus endo-loop for securing the appendicular stump in laparoscopic appendicectomy: a systematic review. Surg Laparosc Endosc Percutan Tech 19:11–15. https://doi.org/10.1097/SLE.0b013e31818a66ab
doi: 10.1097/SLE.0b013e31818a66ab
pubmed: 19238059
Cipe G, Idiz O, Hasbahceci M, Bozkurt S, Kadioglu H, Coskun H, Karatepe O, Muslumanoglu M (2014) Laparoscopic versus open appendectomy: where are we now? Chirurgia (Bucur) 109:518–522
Sohn M, Agha A, Bremer S, Lehmann KS, Bormann M, Hochrein A (2017) Surgical management of acute appendicitis in adults: a review of current techniques. Int J Surg 48:232–239. https://doi.org/10.1016/j.ijsu.2017.11.028
doi: 10.1016/j.ijsu.2017.11.028
pubmed: 29155250
Di Saverio S, Mandrioli M, Sibilio A, Smerieri N, Lombardi R, Catena F, Ansaloni L, Tugnoli G, Masetti M, Jovine E (2014) A cost-effective technique for laparoscopic appendectomy: outcomes and costs of a case-control prospective single-operator study of 112 unselected consecutive cases of complicated acute appendicitis. J Am Coll Surg 218:e51–65. https://doi.org/10.1016/j.jamcollsurg.2013.12.003
doi: 10.1016/j.jamcollsurg.2013.12.003
pubmed: 24559968
Ortega AE, Hunter JG, Peters JH, Swanstrom LL, Schirmer B (1995) A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. Laparoscopic Appendectomy Study Group. Am J Surg 169:208–212. https://doi.org/10.1016/s0002-9610(99)80138-x
doi: 10.1016/s0002-9610(99)80138-x
pubmed: 7840381
Lucchi A, Berti P, Grassia M, Siani LM, Gabbianelli C, Garulli G (2017) Laparoscopic appendectomy: Hem-o-lok versus Endoloop in stump closure. Updates Surg 69:61–65. https://doi.org/10.1007/s13304-016-0413-9
doi: 10.1007/s13304-016-0413-9
pubmed: 28013455
Takami T, Yamaguchi T, Yoshitake H, Hatano K, Kataoka N, Tomita M, Makimoto S (2019) A clinical comparison of laparoscopic versus open appendectomy for the treatment of complicated appendicitis: historical cohort study. Eur J Trauma Emerg Surg. https://doi.org/10.1007/s00068-019-01086-5
doi: 10.1007/s00068-019-01086-5
pubmed: 30710176
pmcid: 7429533
Shimoda M, Maruyama T, Nishida K, Suzuki K, Tago T, Shimazaki J, Suzuki S (2018) Comparison of clinical outcome of laparoscopic versus open appendectomy, single center experience. Heliyon 4:e00635. https://doi.org/10.1016/j.heliyon.2018.e00635
doi: 10.1016/j.heliyon.2018.e00635
pubmed: 29872767
pmcid: 5986549
Galatioto C, Guadagni S, Zocco G, Mazzilo M, Bagnato C, Lippolis PV, Seccia M (2013) Mesoappendix and appendix stump treatment in laparoscopic appendectomy: a retrospective study in 1084 patients. Ann Ital Chir 84:269–274
pubmed: 23856524
Gorter RR, Heij HA, Eker HH, Kazemier G (2014) Laparoscopic appendectomy: state of the art. tailored approach to the application of laparoscopic appendectomy? Best Pract Res Clin Gastroenterol 28:211–224. https://doi.org/10.1016/j.bpg.2013.11.016
doi: 10.1016/j.bpg.2013.11.016
pubmed: 24485267
Antoniou SA, Mavridis D, Hajibandeh S, Hajibandeh S, Antoniou GA, Gorter R, Tenhagen M, Koutras C, Pointner R, Chalkiadakis GE, Granderath F-A, Fragiadakis GF, Philalithis AE, Bonjer HJ (2017) Optimal stump management in laparoscopic appendectomy: a network meta-analysis by the Minimally Invasive Surgery Synthesis of Interventions and Outcomes Network. Surgery 162:994–1005. https://doi.org/10.1016/j.surg.2017.07.013
doi: 10.1016/j.surg.2017.07.013
pubmed: 28864100
Aziret M, Çetinkünar S, Erdem H, Kahramanca Ş, Bozkurt H, Dülgeroğlu O, Yıldırım AC, İrkörücü O, Gölboyu EB (2017) Comparison of open appendectomy and laparoscopic appendectomy with laparoscopic intracorporeal knotting and glove endobag techniques: a prospective observational study. Turk J Surg 33:258–266. https://doi.org/10.5152/turkjsurg.2017.3583
doi: 10.5152/turkjsurg.2017.3583
pubmed: 29260130
pmcid: 5731561
Partecke LI, Kessler W, Diedrich S, von Bernstorff W, Heidecke C-D, Patrzyk M (2013) Disease-adapted closure of the appendicular stump in laparoscopic appendectomy. Zentralbl Chir 138:262–269. https://doi.org/10.1055/s-0031-1283908
doi: 10.1055/s-0031-1283908
pubmed: 22426966
Al-Temimi MH, Berglin MA, Kim EG, Tessier DJ, Johna SD (2017) Discussion of: “Endostapler versus Hem-O-Lok clip to secure the appendiceal stump and mesoappendix during laparoscopic appendectomy”. Am J Surg 214:1149–1150. https://doi.org/10.1016/j.amjsurg.2017.10.006
doi: 10.1016/j.amjsurg.2017.10.006
pubmed: 29054445
Sadat-Safavi SA, Nasiri S, Shojaiefard A, Jafari M, Abdehgah AG, Notash AY, Soroush A (2016) Comparison the effect of stump closure by endoclips versus endoloop on the duration of surgery and complications in patients under laparoscopic appendectomy: a randomized clinical trial. J Res Med Sci. https://doi.org/10.4103/1735-1995.192503
doi: 10.4103/1735-1995.192503
pubmed: 28163733
pmcid: 5244687
Delibegović S (2012) The use of a single Hem-o-lok clip in securing the base of the appendix during laparoscopic appendectomy. J Laparoendosc Adv Surg Tech A 22:85–87. https://doi.org/10.1089/lap.2011.0348
doi: 10.1089/lap.2011.0348
pubmed: 22145605
Bali İ, Karateke F, Özyazıcı S, Kuvvetli A, Oruç C, Menekşe E, Emir S, Özdoğan M (2015) Comparison of intracorporeal knotting and endoloop for stump closure in laparoscopic appendectomy. Ulus Travma Acil Cerrahi Derg 21:446–449
pubmed: 27054634
Mayir B, Ensari CÖ, Bilecik T, Aslaner A, Oruç MT (2015) Methods for closure of appendix stump during laparoscopic appendectomy procedure. Ulus Cerrahi Derg 31:229–231. https://doi.org/10.5152/UCD.2015.2768
doi: 10.5152/UCD.2015.2768
pubmed: 26668532
pmcid: 4674045
Yıldız I, Koca Y (2016) Is there an ideal stump closure technique in laparoscopic appendectomy? Surg Technol Int 28:117–120
pubmed: 27121413
Delibegović S, Mehmedovic Z (2018) The influence of the different forms of appendix base closure on patient outcome in laparoscopic appendectomy: a randomized trial. Surg Endosc 32:2295–2299. https://doi.org/10.1007/s00464-017-5924-z
doi: 10.1007/s00464-017-5924-z
pubmed: 29098432
Kazemier G, Hof KH, Saad S, Bonjer HJ, Sauerland S (2006) Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling? Surg Endosc 20:1473–1476. https://doi.org/10.1007/s00464-005-0525-7
doi: 10.1007/s00464-005-0525-7
pubmed: 16823654
Beldi G, Vorburger SA, Bruegger LE, Kocher T, Inderbitzin D, Candinas D (2006) Analysis of stapling versus endoloops in appendiceal stump closure. Br J Surg 93:1390–1393. https://doi.org/10.1002/bjs.5474
doi: 10.1002/bjs.5474
pubmed: 16862615
Caglià P, Tracia A, Spataro D, Borzì L, Lucifora B, Tracia L, Amodeo C (2014) Appendix stump closure with endoloop in laparoscopic appendectomy. Ann Ital Chir 85:606–609
pubmed: 25712546
Sohn M, Hoffmann M, Pohlen U, Lauscher JC, Zurbuchen U, Holmer C, Buhr HJ, Lehmann KS (2014) Stump closure in laparoscopic appendectomy. Influence of endoloop or linear stapler on patient outcome. Chirurg 85:46–50. https://doi.org/10.1007/s00104-013-2549-1
doi: 10.1007/s00104-013-2549-1
pubmed: 23780410
Sahm M, Kube R, Schmidt S, Ritter C, Pross M, Lippert H (2011) Current analysis of endoloops in appendiceal stump closure. Surg Endosc 25:124–129. https://doi.org/10.1007/s00464-010-1144-5
doi: 10.1007/s00464-010-1144-5
pubmed: 20552371
Van Rossem CC, van Geloven AAW, Schreinemacher MHF, Bemelman WA, Snapshot Appendicitis Collaborative Study Group (2017) Endoloops or endostapler use in laparoscopic appendectomy for acute uncomplicated and complicated appendicitis : no difference in infectious complications. Surg Endosc 31:178–184. https://doi.org/10.1007/s00464-016-4951-5
doi: 10.1007/s00464-016-4951-5
pubmed: 27129569
Swank HA, van Rossem CC, van Geloven AAW, Hof KH, Kazemier G, Meijerink WJHJ, Lange JF, Bemelman WA (2014) Endostapler or endoloops for securing the appendiceal stump in laparoscopic appendectomy: a retrospective cohort study. Surg Endosc 28:576–583. https://doi.org/10.1007/s00464-013-3207-x
doi: 10.1007/s00464-013-3207-x
pubmed: 24048816
Beldi G, Muggli K, Helbling C, Schlumpf R (2004) Laparoscopic appendectomy using endoloops: a prospective, randomized clinical trial. Surg Endosc 18:749–750. https://doi.org/10.1007/s00464-003-9156-z
doi: 10.1007/s00464-003-9156-z
pubmed: 15026904
Mehdorn M, Schürmann O, Mehdorn HM, Gockel I (2017) Intended cost reduction in laparoscopic appendectomy by introducing the endoloop: a single center experience. BMC Surg. https://doi.org/10.1186/s12893-017-0277-z
doi: 10.1186/s12893-017-0277-z
pubmed: 28693476
pmcid: 5504743
Rakić M, Jukić M, Pogorelić Z, Mrklić I, Kliček R, Družijanić N, Perko Z, Patrlj L (2014) Analysis of endoloops and endostaples for closing the appendiceal stump during laparoscopic appendectomy. Surg Today 44:1716–1722. https://doi.org/10.1007/s00595-013-0818-8
doi: 10.1007/s00595-013-0818-8
pubmed: 24337502
Kryspin M, Wyrzykowsk D (2018) Outcomes of open and laparoscopic appendectomy with single endoloop stump closure. JSLS. https://doi.org/10.4293/JSLS.2018.00062
doi: 10.4293/JSLS.2018.00062
pubmed: 30607104
pmcid: 6305067
Kim S, Weireter L (2018) Cost effectiveness of different methods of appendiceal stump closure during laparoscopic appendectomy. Am Surg 84:1329–1332
doi: 10.1177/000313481808400847
Granados-Romero JJ, Valderrama-Treviño AI, Barrera-Mera B, Uriarte-Ruíz K, Banegas-Ruiz R, Ceballos-Villalva JC (2018) Comparación entre ligadura con lazo hemostático y engrapadora mecánica lineal para el cierre de base apendicular. Cir Cir 86:428–431
pubmed: 30226495
Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557–564. https://doi.org/10.1016/s0196-0644(86)80993-3
doi: 10.1016/s0196-0644(86)80993-3
pubmed: 3963537
Kollár D, McCartan DP, Bourke M, Cross KS, Dowdall J (2015) Predicting acute appendicitis? A comparison of the Alvarado score, the Appendicitis Inflammatory Response Score and clinical assessment. World J Surg 39:104–109. https://doi.org/10.1007/s00268-014-2794-6
doi: 10.1007/s00268-014-2794-6
pubmed: 25245432
Tinelli A, Gasbarro N, Lupo P, Malvasi A, Tsin DA, Davila F, Dominguez G, Mettler L, Wetter PA (2012) Safe introduction of ancillary trocars. J Soc Laparosc Surg 16:276–279. https://doi.org/10.4293/108680812x13427982376464
doi: 10.4293/108680812x13427982376464
Vitale SG, Gasbarro N, Lagana AS, Sapia F, Rapisarda AMC, Valenti G, Trovato MA, Rossetti D, Chiofalo B, Barrasso G, Tinelli A (2016) Corrado F (2016) Safe introduction of ancillary trocars in gynecological surgery: the "yellow island" anatomical landmark. Ann Ital Chir 87:608–611
pubmed: 27909270
Chu T, Chandhoke RA, Smith PC, Schwaitzberg SD (2011) The impact of surgeon choice on the cost of performing laparoscopic appendectomy. Surg Endosc 25:1187–1191. https://doi.org/10.1007/s00464-010-1342-1
doi: 10.1007/s00464-010-1342-1
pubmed: 20835717
Ghezzi F, Cromi A, Uccella S, Bogani G, Serati M, Bolis P (2012) Transumbilical versus transvaginal retrieval of surgical specimens at laparoscopy: a randomized trial. Am J Obstet Gynecol. https://doi.org/10.1016/j.ajog.2012.05.016
doi: 10.1016/j.ajog.2012.05.016
pubmed: 22704766
Chou LY, Sheu BC, Chang DY, Huang SC, Chen SY, Hsu WC, Chang WC (2010) Comparison between transumbilical and transabdominal ports for the laparoscopic retrieval of bening adnexal masses: a randomized trial. Eur J Obstet Gynecol Reprod Biol 153:198–202. https://doi.org/10.1016/j.ejogrb.2010.07.029
doi: 10.1016/j.ejogrb.2010.07.029
pubmed: 20705381
Ghezzi F, Cromi A, Uccella S, Siesto G, Bergamini V (2008) Bolis P (2008) Transumbilical surgical specimen retrieval: a viable refinement of laparoscopic surgery for pelvic masses. BJOG 115:1316–1320. https://doi.org/10.1111/j.1471-0528.2008.01802.x
doi: 10.1111/j.1471-0528.2008.01802.x
pubmed: 18715419
Lagana AS, Vitale SG, Palmara V, Ban Frangez H, Triolo O (2017) (2017) Transvaginal specimen removal in minimally invasive surgery: feasibility and possible complications during the incision of the posterior wall. World J Urol 35:1155–1156. https://doi.org/10.1007/s00345-016-1955-7
doi: 10.1007/s00345-016-1955-7
pubmed: 27757537
Uccella S, Cromi A, Bogani G, Casarin J, Serati M, Ghezzi F (2013) Transvaginal specimen extraction at laparoscopy without concomitant hysterectomy: our experience and systematic review of the literature. J Minim Invasive Gynecol 20(5):583–590. https://doi.org/10.1016/j.jmig.2013.02.022
doi: 10.1016/j.jmig.2013.02.022
pubmed: 23623269
Buttice S, Sener TE, Lucan VC, Lunelli L, Lagana AS, Vitale SG, Netsch C, Tanidir Y, Pappalardo R, Magno C (2016) Hybrid transvaginal notes nephrectomy: postoperative sexual outcomes: a three-center matched study. Urology 99:131–135. https://doi.org/10.1016/j.urology.2016.09.023
doi: 10.1016/j.urology.2016.09.023
pubmed: 27693574
Sturlese E, Triolo O, Grasso R, Lagana AS, Retto A, Rossetti D, Vitale SG, Sarpietro G, De Dominici R (2017) Thromboembolism prophylaxis in laparoscopic surgery for gynecologic benign disease. Results of a single center experience in 922 procedures. Ann Ital Chir 88:342–347
pubmed: 28590256
Antonacci N, Ricci C, Taffurelli G, Monari F, Del Governatore M, Caira A, Leone A, Cervellera M, Minni F, Cola B (2015) Laparoscopic appendectomy: which factors are predictors of conversion? A high-volume prospective cohort study. Int J Surg 21:103–107. https://doi.org/10.1016/j.ijsu.2015.06.089
doi: 10.1016/j.ijsu.2015.06.089
pubmed: 26231996
Finnerty BM, Wu X, Giambrone GP, Gaber-Baylis LK, Zabih R, Bhat A, Zarnegar R, Pomp A, Fleischut P, Afaneh C (2017) Conversion-to-open in laparoscopic appendectomy: a cohort analysis of risk factors and outcomes. Int J Surg 40:169–175. https://doi.org/10.1016/j.ijsu.2017.03.016
doi: 10.1016/j.ijsu.2017.03.016
pubmed: 28285058
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 1360123
pmcid: 1360123
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2
doi: 10.1097/SLA.0b013e3181b13ca2
pubmed: 19638912
pmcid: 19638912
Klima S (1998) Importance of appendix stump management in laparoscopic appendectomy. Zentralbl Chir 123(Suppl 4):90–93
pubmed: 9880884
Semm K (1991) Technical surgical steps of endoscopic appendectomy. Langenbecks Arch Chir 376:121–126
doi: 10.1007/BF01263469
Granados-Romero J, Valderrama-Trevino A, Barrera-Mera B, Uriarte-Ruiz K, Banegas-Ruiz R, Ceballos-Villalva J (2018) Comparación Entre Ligadura Con Lazo Hemostático Y Engrapadora Mecánica Lineal Para El Cierre De Base Apendicular. Cir Cir 86(5):428–431. https://doi.org/10.24875/CIRU.18000258
doi: 10.24875/CIRU.18000258
pubmed: 30226495
Mannu GS, Sudul MK, Bettencourt-Silva JH, Cumber E, Li F, Clark AB, Loke YK (2017) Closure methods of the appendix stump for complications during laparoscopic appendectomy. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD006437.pub3
doi: 10.1002/14651858.CD006437.pub3
pubmed: 29190038
pmcid: 6486128