Stapler or endoloop closure of the appendiceal stump in laparoscopic appendectomy.

Laparoscopic appendectomy is the treatment of choice for appendicitis provided sufficient laparoscopic expertise is available. Infectious complications (wound infection and intra-abdominal abscesses) following laparoscopic appendectomy are however not uncommon and can lead to reinterventions, additional treatment and prolonged hospital stay. A safer and easier stump closure technique using an endostapler rather than the standard loop closure has shown to be effective in reducing the number of infections complications but is associated with higher costs (+/- 700€). In a cost-effectiveness multicenter study alongside a randomized trial we will determine the clinical effectiveness, quality of life and costs associated with both approaches.

Primary outcome parameters are superficial and intra-abdominal infections. Secondary outcome parameters are postoperative quality of life at 2, 4 and 12 weeks (SF-36, EQ-5D) operating time, conversion rate, overall morbidity, hospital stay, return to work or school, direct and indirect medical costs. A sample size of 600 patients per treatment arm will be able to detect a difference in superficial and intra-abdominal infections from 8% in the standard loop group to 4% in the endoloop closure group.

Superficial and intra-abdominal infections: 8% in the standard loop group to 4% in the endoloop closure group.

Follow-up at two, four and twelve weeks.

1. Laparoscopic appendectomy with endostapled stump closure;

2. Laparoscopic appendectomy with endolooped stump closure.