Article

Surgical Endoscopy

, Volume 24, Issue 2, pp 383-389

Laparoscopy: a safe approach to appendicitis during pregnancy

  • Eran SadotAffiliated withDepartment of Surgery, Division of General Surgery, The Mount Sinai Hospital
  • , Dana A. TelemAffiliated withDepartment of Surgery, Division of General Surgery, The Mount Sinai Hospital
  • , Manjit AroraAffiliated withDepartment of Surgery, Division of General Surgery, The Mount Sinai Hospital
  • , Parag ButalaAffiliated withDepartment of Surgery, Division of General Surgery, The Mount Sinai Hospital
  • , Scott Q. NguyenAffiliated withDepartment of Surgery, Division of General Surgery, The Mount Sinai Hospital
  • , Celia M. DivinoAffiliated withDepartment of Surgery, Division of General Surgery, The Mount Sinai HospitalDepartment of Surgery, The Mount Sinai Medical Center Email author 

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Abstract

Background

The aim of this study was to evaluate laparoscopic versus open surgery for suspected appendicitis during pregnancy.

Methods

A hospital-based retrospective review of 65 consecutive pregnant patients who underwent surgery for suspected appendicitis from 1999 to 2008 was performed. Significance was determined by Pearson’s χ2 test, Fisher’s exact test, Mann–Whitney test, and Kruskal–Wallis test.

Results

Of the 65 patients, 48 cases were laparoscopic and 17 open. Use of the laparoscopic versus open approach was significantly increased in the first (100% vs. 0%, p < 0.001) and second trimesters (73% vs. 27%, p < 0.001). The open approach was used more frequently in third-trimester patients (71% vs. 29%, p = NS). Significance was demonstrated in mean length of hospital stay in the laparoscopic versus open group (3.4 vs. 4.2 days, p = 0.001). No maternal mortalities occurred. Follow-up of fetal outcome was achieved in 89% of patients. No difference was demonstrated in fetal loss (1 in laparoscopic group), APGAR score, birth weight, and preterm delivery rate by operative approach. Adverse outcome was associated with maternal temperature greater than 38°C, leukocytosis greater than 16 × 109/l, or more than 48 h between onset of symptoms and emergency room presentation.

Conclusions

This article is the largest hospital-based series evaluating the laparoscopic versus open approach for pregnant patients with presumed acute appendicitis. While methodological limitations preclude a definitive recommendation, laparoscopy appears to be a safe, feasible, and efficacious approach for pregnant patients with presumed acute appendicitis. We conclude that it is likely not the surgical approach but the underlying diagnosis combined with maternal factors that determine the risk for pregnancy complications. A benefit of laparoscopy is the diagnostic ability to identify other intra-abdominal pathology which may mimic appendicitis and harbor pregnancy risks.

Keywords

Laparoscopy Diagnostic laparoscopy Appendicitis Appendectomy Pregnancy