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Association of laparoscopy and laparotomy with adverse fetal outcomes: a retrospective population-based case–control study

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Abstract

Background

This study aimed to evaluate fetal adverse outcomes of laparoscopy and laparotomy in pregnant women to determine the safety of these surgical approaches.

Methods

This was a retrospective nationwide case–control study of women who became pregnant for the first time between 2000 and 2012 in Taiwan. The case (with adverse fetal outcomes) and control groups comprised 208,604 and 417,124 participants, respectively. Participants who underwent appendectomy, cholecystectomy, ovarian cystectomy, or myomectomy were treated with either laparoscopy or laparotomy. A conditional logistic regression model was used to calculate the odds ratios (ORs) for adverse fetal outcomes.

Results

The laparotomy and laparoscopy groups comprised 632 and 536 patients, respectively. Women who underwent laparoscopy had a significantly higher risk of adverse fetal outcomes (adjusted OR [AOR] = 2.33; 95% CI 1.66–2.99) than those who underwent laparotomy. Adverse fetal outcomes were found to be significantly associated with laparoscopy among women aged 20–39 years (AOR = 2.30; 95% CI 1.70–3.31). Regarding surgical indication, unlike laparotomy, laparoscopic cholecystectomy and appendectomy were not associated with adverse fetal outcomes. However, laparoscopic myomectomy and ovarian surgeries were associated with a higher incidence of adverse fetal outcomes than the laparotomy group (AOR = 2.29 [95% CI 1.57–3.35, p < 0.0001] and AOR = 2.52 [95% CI 1.58–4.04, p = 0.0001], respectively).

Conclusions

Pregnant women who underwent laparoscopic surgery experienced significantly more adverse fetal outcomes than those who underwent laparotomy. Therefore, pregnant women undergoing either laparotomy or laparoscopy should be informed of the risk of adverse fetal outcomes.

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Funding

This study is supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW108-TDU-B-212-133004), China Medical University Hospital, Academia Sinica Stroke Biosignature Project (BM10701010021), MOST Clinical Trial Consortium for Stroke (MOST 107-2321-B-039 -004-), Tseng-Lien Lin Foundation, Taichung, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, No. 707, Chung-Yang Rd., Sec. 3, Hualien, Taiwan

    Ying-Hsi Chen, Pei-Chen Li & Dah-Ching Ding

  2. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Yu-Cih Yang

  3. College of Medicine, China Medical University, Taichung, Taiwan

    Yu-Cih Yang

  4. Department of Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan

    Jen-Hung Wang

  5. Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan

    Shinn-Zong Lin

  6. Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan

    Dah-Ching Ding

Authors
  1. Ying-Hsi Chen
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  2. Pei-Chen Li
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  3. Yu-Cih Yang
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  6. Dah-Ching Ding
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Contributions

YH Chen, PC Li: manuscript preparation; YC Yang: data analysis, manuscript preparation; JH Wang: study design, manuscript preparation; SZ Lin: study design, manuscript preparation; DC Ding: study concepts, design and manuscript preparation, and revision. All authors: final approval of the manuscript.

Corresponding author

Correspondence to Dah-Ching Ding.

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Disclosures

Ying-Hsi Chen, Pei-Chen Li, Yu-Cih Yang, Jen-Hung Wang, Shinn-Zong Lin, and Dah-Ching Ding have no conflicts of interest or financial ties to disclose.

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Chen, YH., Li, PC., Yang, YC. et al. Association of laparoscopy and laparotomy with adverse fetal outcomes: a retrospective population-based case–control study. Surg Endosc 35, 6048–6054 (2021). https://doi.org/10.1007/s00464-020-08094-2

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  • DOI: https://doi.org/10.1007/s00464-020-08094-2

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