{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:58:37Z","timestamp":1781632717059,"version":"3.54.5"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Securing the appendiceal stump is a critical step in laparoscopic appendicectomy, the gold-standard treatment for managing acute appendicitis. Endoloops are widely used in appendiceal stump ligation owing to their simplicity and cost-effectiveness, but practice varies between surgeons in the use of one or two loops. This study aimed to compare outcomes between single and double endoloop closure and to explore surgeon perspectives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A mixed methods approach was used to compare the use of one or two endoloops. A retrospective cohort analysis included patients undergoing laparoscopic appendicectomy in a UK district general hospital between August 2023 and January 2025, comparing post-operative complications and operating time between single and double endoloop ligation. Overall complications were defined as any complications within the 30-day post-operative period while clinically relevant complications referred to intra-abdominal abscess, stump leak, or stump appendicitis. A focus group of operating surgeons was analysed thematically to explore decision-making factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 191 patients included, 50 (26%) received a single endoloop and 141 (74%) received two. No statistically significant difference in clinically relevant 30-day complications was observed (12% vs. 9.9%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.07) with overlapping confidence intervals for all complication outcomes. Operative time was shorter in the single-endoloop group (84\u2009\u00b1\u200941.5 vs. 108.5\u2009\u00b1\u200931.9\u00a0min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). Thematic analysis identified three key influences on endoloop choice: perceived security through tradition, assessment of appendiceal base integrity, and training considerations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>No statistically significant difference in clinically relevant post-operative complications was observed between single and double endoloop closure, although the study may be underpowered to detect rare events. Single endoloop closure was associated with a shorter operative time, which may be partly confounded by disease severity. Surgical decision-making remains influenced by training culture and tradition rather than evidence-based practice, and full standardisation is challenging given variability in case complexity and surgeon expertise.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12893-026-03544-5","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T05:24:18Z","timestamp":1770009858000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Single or double endoloop ligation in laparoscopic appendicectomy: a mixed-methods study of clinical outcomes and surgeon perspectives"],"prefix":"10.1186","volume":"26","author":[{"given":"Lara","family":"Nassar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miqdad","family":"Qandeel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philobater","family":"Awad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basma","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Alim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimena Alvarez Del Castillo","family":"Gonzalez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Makkiyah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasim","family":"Al-Musawi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"3544_CR1","unstructured":"Nguyen A, Lotfollahzadeh S. Appendectomy. In: StatPearls. Treasure Island: StatPearls Publishing; 2025. [cited 2025 Mar 8]. Available from: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK580514\/."},{"issue":"1","key":"3544_CR2","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1007\/s00423-024-03452-3","volume":"409","author":"Q Najah","year":"2024","unstructured":"Najah Q, Makhlouf HA, Abusalah MA, Aboelkhier MM, Rashed MA, Kashbour M, et al. Effectiveness of different appendiceal stump closure methods in laparoscopic appendectomy: a network meta-analysis. Langenbecks Arch Surg. 2024;409(1):270.","journal-title":"Langenbecks Arch Surg"},{"key":"3544_CR3","doi-asserted-by":"crossref","unstructured":"Jaschinski T, Mosch CG, Eikermann M, Neugebauer EA, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2018;(11):CD001546. [cited 2025 Mar 8]. Available from: https:\/\/www.cochranelibrary.com\/cdsr\/doi\/10.1002\/14651858.CD001546.pub4\/full.","DOI":"10.1002\/14651858.CD001546.pub4"},{"issue":"11","key":"3544_CR4","first-page":"CD006437","volume":"2017","author":"GS Mannu","year":"2017","unstructured":"Mannu GS, Sudul MK, Bettencourt-Silva JH, Cumber E, Li F, Clark AB, et al. Closure methods of the appendix stump for complications during laparoscopic appendectomy. Cochrane Database Syst Rev. 2017;2017(11):CD006437.","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"3544_CR5","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1007\/s00423-023-03012-1","volume":"408","author":"Y Rudnicki","year":"2023","unstructured":"Rudnicki Y, Soback H, Tibi N, Gutwetter N, Ken-Dror S, Avital S. Appendiceal stump closure in laparoscopic appendectomy: one endoloop vs two endoloops vs two endoclips\u2014does it matter? 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BMC Surg. 2017;17(1):80.","journal-title":"BMC Surg"},{"issue":"9","key":"3544_CR8","doi-asserted-by":"publisher","first-page":"1716","DOI":"10.1007\/s00595-013-0818-8","volume":"44","author":"M Raki\u0107","year":"2014","unstructured":"Raki\u0107 M, Juki\u0107 M, Pogoreli\u0107 Z, Mrkli\u0107 I, Kli\u010dek R, Dru\u017eijani\u0107 N, et al. Analysis of endoloops and endostaples for closing the appendiceal stump during laparoscopic appendectomy. Surg Today. 2014;44(9):1716\u201322.","journal-title":"Surg Today"},{"key":"3544_CR9","first-page":"102364","volume":"65","author":"JRC Sheen","year":"2021","unstructured":"Sheen JRC, Bowen JM, Bowling KK. Endoloops in laparoscopic appendicectomy: a retrospective cost-effectiveness analysis. 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Qual Res Psychol. 2006;3(2):77\u2013101.","journal-title":"Qual Res Psychol"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-026-03544-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-026-03544-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-026-03544-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:31:02Z","timestamp":1781631062000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12893-026-03544-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3544"],"URL":"https:\/\/doi.org\/10.1186\/s12893-026-03544-5","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]},"assertion":[{"value":"14 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study received Health Research Authority (HRA) and Health and Care Research Wales (HCRW) approval through the Integrated Research Application System (IRAS project ID: 355719; REC reference: 25\/PR\/0988). In accordance with the HRA and HCRW decision, formal Research Ethics Committee (REC) approval was not required for this study. Local capacity and capability were confirmed by the participating NHS Trust prior to study initiation. The qualitative component involved surgeons only, with written informed consent obtained for participation, audio recording, and the use of anonymous quotations in the manuscript. The study was conducted in accordance with the principles of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"169"}}