Laparoscopy: a safe approach to appendicitis during pregnancy
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The aim of this study was to evaluate laparoscopic versus open surgery for suspected appendicitis during pregnancy.
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.
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.
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.
KeywordsLaparoscopy Diagnostic laparoscopy Appendicitis Appendectomy Pregnancy
- 7.Oelsner G, Stockheim D, Soriano D, Goldenberg M, Seidman DS, Cohen SB, Admon D, Novikov I, Maschiach S, Carp HJ, Anderman S, Ben-Ami M, Ben-Arie A, Hagay Z, Bustan M, Shalev E, Carp H, Gemer O, Golan A, Holzinger M, Beyth Y, Horowitz A, Hamani Y, Keis M, Lavie O, Luxman D, Oelsner G, Stockheim D, Rojansky N, Taichner G, Yafe C, Zohar S, Bilanca B (2003) Pregnancy outcome after laparoscopy or laparotomy in pregnancy. J Am Assoc Gynecol Laparosc 10(2):200–204CrossRefPubMedGoogle Scholar
- 13.American College of Obstetricians and Gynecologists (2001) ACOG Practice Bulletin. Assessment of risk factors for preterm birth. Clinical management guidelines for obstetrician-gynecologists. Number 31, October 2001 (replaces Technical Bulletin number 206, June 1995; Committee Opinion number 172, May 1996; Committee Opinion number 187, September 1997; Committee Opinion number 198, February 1998; and Committee Opinion number 251, January 2001). Obstet Gynecol 98(4):709-716Google Scholar
- 14.Cunningham FG, Leveno KL, Bloom SL, Hauth JC, Gilstrap LC III, Wenstrom KD, (eds) (2005) Chapter 8. Prenatal care. In: Williams obstetrics, 22nd edn. http://www.accessmedicine.com/content.aspx?aID=742204
- 20.Lemieux P, Rheaume P, Levesque I, Bujold E, Brochu G (2009) Laparoscopic appendectomy in pregnant patients: a review of 45 cases. Surg Endosc. doi:10.1007/s00464-008-0201-9
- 27.Yumi H (2008) Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy: this statement was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), September 2007. It was prepared by the SAGES Guidelines Committee. Surg Endosc 22(4):849–861CrossRefPubMedGoogle Scholar