title: Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy.
abstract: BACKGROUND
  Laparoscopic appendicectomy has gained wide acceptance as an alternative to open appendicectomy during pregnancy. However, data regarding the safety and optimal surgical approach to appendicitis in pregnancy are still controversial.
  
  
  METHODS
  This was a systematic review and meta-analysis of studies comparing laparoscopic and open appendicectomy in pregnancy identified using PubMed and Scopus search engines from January 1990 to July 2011. Two reviewers independently extracted data on fetal loss, preterm delivery, wound infection, duration of operation, hospital stay, Apgar score and birth weight between laparoscopic and open appendicectomy groups.
  
  
  RESULTS
  Eleven studies with a total of 3415 women (599 in laparoscopic and 2816 in open group) were included in the analysis. Fetal loss was statistically significantly worse in those who underwent laparoscopy compared with open appendicectomy; the pooled relative risk (RR) was 1·91 (95 per cent confidence interval (c.i.) 1·31 to 2·77) without heterogeneity. The pooled RR for preterm labour was 1·44 (0·68 to 3·06), but this risk was not statistically significant. The mean difference in length of hospital stay was - 0·49 (-1·76 to - 0·78) days, but this was not clinically significant. No significant difference was found for wound infection, birth weight, duration of operation or Apgar score.
  
  
  CONCLUSIONS
  The available low-grade evidence suggests that laparoscopic appendicectomy in pregnant women might be associated with a greater risk of fetal loss.
authors.affiliation: Department of Surgery, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: C
authors.initials: C
authors.lastname: Wilasrusmee
authors.forename: B
authors.initials: B
authors.lastname: Sukrat
authors.forename: M
authors.initials: M
authors.lastname: McEvoy
authors.forename: J
authors.initials: J
authors.lastname: Attia
authors.forename: A
authors.initials: A
authors.lastname: Thakkinstian
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000379:methods / Q000592:standards*; D001064:Appendicitis / Q000601:surgery*; D005260:Female; D005313:Fetal Death / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000592:standards*; D007902:Length of Stay; D007752:Obstetric Labor, Premature / Q000209:etiology; D061646:Operative Time; D061214:Patient Safety; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D011256:Pregnancy Outcome