Loop ileostomy closure: comparison of cost effectiveness between suture and stapler

World J Surg. 2010 Dec;34(12):2867-71. doi: 10.1007/s00268-010-0787-7.


Background: Closure of loop ileostomy can be safely performed using sutures or staplers. The aim of the present study was to compare the cost effectiveness of three different techniques.

Methods: A total of 128 consecutive patients who underwent closure of loop ileostomy between January 2002 and December 2008 were analyzed retrospectively. The primary outcome parameter was operative cost.

Results: Closure of ileostomy was performed in 66 patients with hand-sewn anastomosis, in 25 patients with stapler only, and in 37 patients with a combination of stapler and suture. There were no differences in terms of early and late postoperative complications. Operative time was significantly longer for "suture only" (101.4 ± 26 min) than for "stapler/suture" (-4.9 min) and "stapler only" (-17.8 min); the difference between the three groups is significant (p = 0.05). Duration of hospital stay was not different among the three groups. Operative costs with "stapler/suture" (1,755.9 ± 355.6 EUR) were significantly higher than with "suture only" (-254 EUR; p = 0.001) and "stapler only" (-236 EUR; p = 0.005).

Conclusions: Operative time using the stapler only is significantly shorter than with hand-sewn anastomosis or combinations of stapler and suture. Operative costs are significantly higher for a procedure that includes suture and stapler.

MeSH terms

  • Adult
  • Aged
  • Anastomosis, Surgical / economics
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Ileostomy*
  • Male
  • Middle Aged
  • Surgical Stapling / economics
  • Suture Techniques / economics*
  • Treatment Outcome