Endoloop Versus LigaSure for Appendiceal Stump Closure in Pediatric Laparoscopic Appendectomy: A Multicenter Prospective Trial.

Abstract

Background: Appendiceal stump closure is critical in laparoscopic appendectomy (LA) to prevent complications such as stump leakage and intra-abdominal abscess formation. This study aims to evaluate the safety and effectiveness of LigaSure™ versus Endoloop for appendiceal stump closure in pediatric LA. Methods: This prospective multicenter comparative study included 199 pediatric patients who underwent LA between May 2021 and October 2023 at two pediatric surgery clinics. Patients were allocated to the LigaSure group (n = 74) or Endoloop group (n = 125) based on the surgeon's intraoperative preference. Data collected included demographic characteristics, laboratory and radiological findings, intraoperative details, postoperative complications, and histopathological measurements of appendiceal and lumen diameters. Statistical analyses were performed using the independent samples t-test and chi-square test, with significance at P < .05. Results: No significant differences were observed between groups regarding age (P = .670), gender (P = .439), leukocyte count (P = .072), or C-reactive protein levels (P = .368). Complicated appendicitis was more prevalent in the LigaSure group (12.2%) compared to the Endoloop group (5.6%). No intra-abdominal abscesses or stump leakage were reported in either group. Histopathological analysis revealed no significant difference in mean appendiceal diameter (LigaSure: 8.9 ± 0.2 mm; Endoloop: 8.9 ± 0.1 mm; P = .743) or lumen diameter (P = .096). The largest lumen diameter measured in appendix specimens was 5113 μm, while the smallest was 255.6 μm (P = .096). No cases of intra-abdominal abscess or stump leakage were reported. The mean hospital stay was comparable (LigaSure: 2 ± 0.2 days; Endoloop: 2 ± 0.1 days; P = .068). Conclusion: LigaSure™ is a safe and effective alternative to Endoloop for appendiceal stump closure in pediatric LA. The device's ability to provide a secure seal makes it a reliable option, even in cases of complicated appendicitis.