Laparoscopy: a safe approach to appendicitis during pregnancy.
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 chi(2) 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 degrees C, leukocytosis greater than 16 x 10(9)/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.
Sadot
Eran
E
Department of Surgery, Division of General Surgery, The Mount Sinai Hospital, New York, NY 10029, USA. EranSadot@gmail.com
Telem
Dana A
DA
Arora
Manjit
M
Butala
Parag
P
Nguyen
Scott Q
SQ
Divino
Celia M
CM
D018784:Abdominal Abscess / Q000150:complications / Q000601:surgery; D000328:Adult; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D001063:Appendiceal Neoplasms / Q000175:diagnosis / Q000601:surgery; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D002276:Carcinoid Tumor / Q000175:diagnosis / Q000601:surgery; D002821:Chorioamnionitis / Q000209:etiology; D005184:Fallopian Tube Diseases / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005734:Gangrene / Q000150:complications; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007752:Obstetric Labor, Premature / Q000209:etiology; D010049:Ovarian Diseases / Q000175:diagnosis / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery*; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000601:surgery; D011256:Pregnancy Outcome; D011264:Pregnancy Trimesters; D012189:Retrospective Studies; D014102:Torsion Abnormality / Q000175:diagnosis / Q000601:surgery; D055815:Young Adult