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Laparoscopy: a safe approach to appendicitis during pregnancy

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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.

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References

  1. Mazze RI, Kallen B (1991) Appendectomy during pregnancy: a Swedish registry study of 778 cases. Obstet Gynecol 77(6):835–840

    CAS  PubMed  Google Scholar 

  2. Reedy MB, Kallen B, Kuehl TJ (1997) Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the Swedish Health Registry. Am J Obstet Gynecol 177(3):673–679

    Article  CAS  PubMed  Google Scholar 

  3. Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G (2005) Pregnancy outcome following non-obstetric surgical intervention. Am J Surg 190(3):467–473

    Article  PubMed  Google Scholar 

  4. Ortega AE, Hunter JG, Peters JH, Swanstrom LL, Schirmer B (1995) A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy Laparoscopic Appendectomy Study Group. Am J Surg 169(2):208–212 (discussion 212-213)

    Article  CAS  PubMed  Google Scholar 

  5. Pedersen AG, Petersen OB, Wara P, Ronning H, Qvist N, Laurberg S (2001) Randomized clinical trial of laparoscopic versus open appendicectomy. Br J Surg 88(2):200–205

    Article  CAS  PubMed  Google Scholar 

  6. Sauerland S, Lefering R, Neugebauer EA (2004) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 4:CD001546

    PubMed  Google Scholar 

  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):200–204

    Article  PubMed  Google Scholar 

  8. Costantino GN, Vincent GJ, Mukalian GG, Kliefoth WL Jr (1994) Laparoscopic cholecystectomy in pregnancy. J Laparoendosc Surg 4(2):161–164

    CAS  PubMed  Google Scholar 

  9. Motew M, Ivankovich AD, Bieniarz J, Albrecht RF, Zahed B, Scommegna A (1973) Cardiovascular effects and acid–base and blood gas changes during laparoscopy. Am J Obstet Gynecol 115(7):1002–1012

    CAS  PubMed  Google Scholar 

  10. Ivankovich AD, Miletich DJ, Albrecht RF, Heyman HJ, Bonnet RF (1975) Cardiovascular effects of intraperitoneal insufflation with carbon dioxide and nitrous oxide in the dog. Anesthesiology 42(3):281–287

    Article  CAS  PubMed  Google Scholar 

  11. Thomas SJ, Brisson P (1998) Laparoscopic appendectomy and cholecystectomy during pregnancy: six case reports. JSLS 2(1):41–46

    CAS  PubMed  Google Scholar 

  12. McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM (2007) Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 205(4):534–540

    Article  PubMed  Google 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):709-716

  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

  15. de Perrot M, Jenny A, Morales M, Kohlik M, Morel P (2000) Laparoscopic appendectomy during pregnancy. Surg Laparosc Endosc Percutan Tech 10(6):368–371

    PubMed  Google Scholar 

  16. Friedman JD, Ramsey PS, Ramin KD, Berry C (2002) Pneumoamnion and pregnancy loss after second-trimester laparoscopic surgery. Obstet Gynecol 99(3):512–513

    Article  PubMed  Google Scholar 

  17. Wu JM, Chen KH, Lin HF, Tseng LM, Tseng SH, Huang SH (2005) Laparoscopic appendectomy in pregnancy. J Laparoendosc Adv Surg Tech A 15(5):447–450

    Article  CAS  PubMed  Google Scholar 

  18. Halkic N, Tempia-Caliera AA, Ksontini R, Suter M, Delaloye JF, Vuilleumier H (2006) Laparoscopic management of appendicitis and symptomatic cholelithiasis during pregnancy. Langenbecks Arch Surg 391(5):467–471

    Article  PubMed  Google Scholar 

  19. Lyass S, Pikarsky A, Eisenberg VH, Elchalal U, Schenker JG, Reissman P (2001) Is laparoscopic appendectomy safe in pregnant women? Surg Endosc 15(4):377–379

    Article  CAS  PubMed  Google Scholar 

  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

  21. Rollins MD, Chan KJ, Price RR (2004) Laparoscopy for appendicitis and cholelithiasis during pregnancy: a new standard of care. Surg Endosc 18(2):237–241

    Article  CAS  PubMed  Google Scholar 

  22. Barnes SL, Shane MD, Schoemann MB, Bernard AC, Boulanger BR (2004) Laparoscopic appendectomy after 30 weeks pregnancy: report of two cases and description of technique. Am Surg 70(8):733–736

    PubMed  Google Scholar 

  23. Palanivelu C, Rangarajan M, Parthasarathi R (2006) Laparoscopic appendectomy in pregnancy: a case series of seven patients. JSLS 10(3):321–325

    PubMed  Google Scholar 

  24. Masters K, Levine BA, Gaskill HV, Sirinek KR (1984) Diagnosing appendicitis during pregnancy. Am J Surg 148(6):768–771

    Article  CAS  PubMed  Google Scholar 

  25. Horowitz MD, Gomez GA, Santiesteban R, Burkett G (1985) Acute appendicitis during pregnancy Diagnosis and management. Arch Surg 120(12):1362–1367

    CAS  PubMed  Google Scholar 

  26. Hunt MG, Martin JN Jr, Martin RW, Meeks GR, Wiser WL, Morrison JC (1989) Perinatal aspects of abdominal surgery for nonobstetric disease. Am J Perinatol 6(4):412–417

    Article  CAS  PubMed  Google Scholar 

  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):849–861

    Article  PubMed  Google Scholar 

  28. Wallace CA, Petrov MS, Soybel DI, Ferzoco SJ, Ashley SW, Tavakkolizadeh A (2008) Influence of imaging on the negative appendectomy rate in pregnancy. J Gastrointest Surg 12(1):46–50

    Article  PubMed  Google Scholar 

  29. Flum DR, Morris A, Koepsell T, Dellinger EP (2001) Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 286(14):1748–1753

    Article  CAS  PubMed  Google Scholar 

  30. Tamir IL, Bongard FS, Klein SR (1990) Acute appendicitis in the pregnant patient. Am J Surg 160(6):571–575 (discussion 575–576)

    Article  CAS  PubMed  Google Scholar 

  31. Kumar R, Erian M, Sinnot S, Knoesen R, Kimble R (2002) Laparoscopic appendectomy in modern gynecology. J Am Assoc Gynecol Laparosc 9(3):252–263

    Article  CAS  PubMed  Google Scholar 

  32. Andreoli M, Servakov M, Meyers P, Mann WJ Jr (1999) Laparoscopic surgery during pregnancy. J Am Assoc Gynecol Laparosc 6(2):229–233

    Article  CAS  PubMed  Google Scholar 

  33. Fatum M, Rojansky N (2001) Laparoscopic surgery during pregnancy. Obstet Gynecol Surv 56(1):50–59

    Article  CAS  PubMed  Google Scholar 

  34. Melnick DM, Wahl WL, Dalton VK (2004) Management of general surgical problems in the pregnant patient. Am J Surg 187(2):170–180

    Article  PubMed  Google Scholar 

  35. Moreno-Sanz C, Pascual-Pedreno A, Picazo-Yeste JS, Seoane-Gonzalez JB (2007) Laparoscopic appendectomy during pregnancy: between personal experiences and scientific evidence. J Am Coll Surg 205(1):37–42

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, The Mount Sinai Hospital, New York, NY, 10029, USA

    Eran Sadot, Dana A. Telem, Manjit Arora, Parag Butala, Scott Q. Nguyen & Celia M. Divino

  2. Department of Surgery, The Mount Sinai Medical Center, 5 East 98th Street, Box 1259, 15th Floor, New York, NY, 10029, USA

    Celia M. Divino

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  1. Eran Sadot
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  2. Dana A. Telem
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  3. Manjit Arora
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  4. Parag Butala
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  6. Celia M. Divino
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Correspondence to Celia M. Divino.

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Sadot, E., Telem, D.A., Arora, M. et al. Laparoscopy: a safe approach to appendicitis during pregnancy. Surg Endosc 24, 383–389 (2010). https://doi.org/10.1007/s00464-009-0571-7

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  • DOI: https://doi.org/10.1007/s00464-009-0571-7

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