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Published on: January 17, 2019
Laparoscopic versus open appendicectomy in pregnancy: a systematic review
Colin A Walsh1, Tjun Tang, Stewart R Walsh
1Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 2QQ, UK, UK.
International Journal of Surgery (London, England)
|March 18, 2008
Summary
Laparoscopic appendicectomy in pregnancy has a higher fetal loss rate than open surgery. Open appendicectomy is recommended as the safer option for pregnant women needing appendicitis treatment.
Area of Science:
- Obstetrics and Gynecology
- Surgical Gastroenterology
- Maternal-Fetal Medicine
Background:
- Acute appendicitis is a common surgical emergency during pregnancy.
- Laparoscopic appendicectomy (LA) benefits are established in non-pregnant patients.
- Optimal surgical approach for appendicitis in pregnancy remains debated.
Purpose of the Study:
- To systematically review outcomes of laparoscopic appendicectomy in pregnant women.
- To compare fetal outcomes and complications between laparoscopic and open appendicectomy.
- To evaluate the safety of LA across different trimesters of pregnancy.
Main Methods:
- Systematic review of 637 cases of LA in pregnancy (1990-2007).
- Analysis of pregnancy outcomes, patient characteristics, and complications.
- Comparison of fetal loss and preterm delivery rates with open appendicectomy data.
Main Results:
- Laparoscopic appendicectomy (LA) in pregnancy showed a 6% fetal loss rate, higher than open appendicectomy.
- Fetal loss was highest in complicated appendicitis cases.
- Negative appendicectomy rate was 27%; Hasson technique had 0% entry complications.
- Preterm delivery rates were similar or slightly lower with LA, but under-reported.
Conclusions:
- Laparoscopic appendicectomy (LA) in pregnancy has low intra-operative complication rates.
- However, LA is associated with significantly higher fetal loss compared to open appendicectomy.
- Open appendicectomy is suggested as the safer surgical choice for pregnant women with appendicitis.
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