Endoloops in laparoscopic appendicectomy: A retrospective, cost effectiveness analysis

Over 50,000 appendicectomies are performed in the UK annually. Despite this highvolume. status, and the endoloop being commonly employed, there is a scarcity of literature studying differences in outcomes depending on numbers used.The aim of this study was to investigate whether a significant difference in complication rate exists where different numbers of endoloop ligatures have been applied to the appendiceal base during laparoscopic appendicectomy, and to analyse for potential cost saving. We performed a retrospective analysis of appendicectomies at our centre in one year, providing a sample of 254 patients. Each was followed up for complications in the 30 days post discharge and graded using the Clavien-Dindo system. Our null hypothesis of no difference in complication rate was tested using Fisher's exact test. Of 254 patients, 59 were excluded due to open approach, non-endoloop method, or lack of available record, leaving a population of 195. The result of the two-tailed P value equalled 1.000, indicating no statistically significant difference in complication rate whether one or two endoloops were used. An endoloop costs £13.59. If the 62 cases in which 2 endoloops were used to secure the base had utilised a single endoloop, this would amount to a saving of £842.58. Our study set out to assess whether the complication rate differs in cases where one or two endoloops have been applied. Retrospective statistical analysis found no significant difference between groups. Therefore, we recommend use of one endoloop to secure the base in laparoscopic appendicectomy. •Acute appendicitis is the most common intra-abdominal surgical emergency in the world.•Laparoscopic endoloop provides a low-cost option to safely secure the appendiceal base.•No significant difference was found where using one proximal endoloop vs two proximal endoloops.•Utilising one proximal endoloop leads to cost saving in a high-volume procedure.