A cohort comparative study between laparoscopic and open appendectomy in pregnant women
Keywords:Laparoscopic appendectomy, Open appendectomy, Cohort, Preterm labour
Background: Despite the initial absolute contraindication of laparoscopic surgery during pregnancy, in the last decade, laparoscopic appendectomy (LA) has been performed in pregnant women but to compare the outcomes of LA compared with open appendectomy (OA). The objective of the study was to evaluate the safety and efficacy of LA compared with OA in pregnant women.
Methods: A cohort study was conducted among pregnant women with a diagnosis of acute appendicitis who were undergoing LA or OA between June 2013 to July 2014. Pre-operative data and post-operative complication were monitored. Epi-info 7 was used for analysis.
Results: Sixty patients (20 LA and 40 OA) enrolled in our study. There were no significant differences in duration of surgery, postoperative complication rate and obstetric outcomes, including incidence of preterm labour, delivery type. The mean time to normal bowel movement in the LA group was significantly shorter than that in the OA group. Also, the mean time to adequate oral intake in the LA group was earlier than in the OA group (2.1±0.4 d v. 4.1±1.8 d, p=0.02). Duration of hospital stay in the LA group was 4.1±2.6 days, and that of the OA group was 6.6±3.2 days (p=0.04).
Conclusions: Laparoscopic appendectomy is a clinically safe and current procedure in all trimesters of pregnancy and should be well-thought-out as a standard treatment alternative to OA.
Kirshtein B, Perry ZH, Avinoach E, Mizrahi S, Lantsberg L. Safety of laparoscopic appendectomy during pregnancy. World J Surg. 2009;33:475-80.
Corneille MG, Gallup TM, Bening T, Wolf SE, Brougher C, Myers JG, et al. The use of laparoscopic surgery in pregnancy: evaluation of safety and efficacy. Am J Surg. 2010;200:363-7.
McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM, et al. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg. 2007;205:534-40.
de Bakker JK, Dijksman LM, Donkervoort SC. Safety and outcome of general open and laparoscopic procedures during pregnancy. Surg Endosc. 2011;25:1574-8.
Moreno-Sanz C, Pascual-Pedreño A, Picazo-Yeste JS, Seoane-Gonzalez JB. Laparoscopic appendectomy during pregnancy: between personal experiences and scientific evidence. J Am Coll Surg. 2007;205:37-42.
Upadhyay A, Stanten S, Kazantsev G, Horoupian R, Stanten A. Laparoscopic management of a non-obstetric emergency in the third trimester of pregnancy. Surg Endosc. 2007;21:1344-8.
Carver TW, Antevil J, Egan JC, Brown CV. Appendectomy during early pregnancy: What is the preferred surgical approach? Am Surg. 2005;71:809-12.
Park SH, Park MI, Choi JS, Lee JH, Kim HO, Kim H, et al. Laparoscopic appendectomy per- formed during pregnancy by gynecological laparoscopists. Eur J Obstet Gynecol Reprod Biol. 2010;148:44-8.
Curet MJ, Allen D, Josloff RK, Pitcher DE, Curet LB, Miscall BG, et al. Laparoscopy during pregnancy. Arch Surg. 1996;131:546-50.
Morrell DG, Mullins JR, Harrison PB. Laparoscopic cholecystectomy during pregnancy in symptomatic patients. Surgery. 1992;112:856-9.
Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg. 2005;190:467-73.
Malangoni MA. Gastrointestinal surgery and pregnancy. Gastroenterol Clin North Am 2003;32:181-200.