Laparoscopic appendectomy in pregnant patients: a review of 45 cases

Laparoscopic surgery in pregnancy remains debated, especially in cases of suspected appendicitis. Cases of suspected appendicitis treated by the laparoscopic approach in a single institution over a 10-year period were reviewed (1997-2007). The objectives were to evaluate the immediate complications of the procedure and the outcome of pregnancies including foetal loss and preterm delivery.

Retrospective analysis of 45 consecutive cases of suspected appendicitis during pregnancy was carried out. Forty-two patients (93%) had a preoperative ultrasound, of which 13 (33%) confirmed an acute appendicitis. Out of 45 cases, 15 (33%) had the surgical procedure during the first trimester, 22 (49%) in the second and 8 (18%) in the third. Two (4%) patients had major complications (intra-abdominal abscess and uterine perforation) and two others (4%) had minor complications (cystitis and ileus). No patients underwent delivery in the month following surgery and there was no foetal loss in the follow-up. Three (8.1%) patients delivered prior to 35 weeks' gestation and 18.1% delivered before term (<37 weeks). As previously reported, a high rate of normal appendix (33%) was found at surgery. No significant differences were found in rates of preterm delivery, adverse outcome or operative time between trimesters of pregnancy at the time of surgery. Mean operative time was 49 +/- 19 min.

This large series from a single institution shows a low rate of preterm delivery and absence of foetal loss after laparoscopic appendectomy. Regardless of trimester, the low rate of complication makes it a valuable option for pregnant patients with suspicion of acute appendicitis. The rate of normal appendectomies remaining high, efforts have to be made towards new diagnostic modalities to lower the negative appendectomy rate in this specific population.