Laparoscopy: a safe approach to appendicitis during pregnancy

Area of Science:

• Obstetrics and Gynecology
• Surgical Oncology
• Gastroenterology

Background:

• Appendicitis during pregnancy presents diagnostic and therapeutic challenges.
• Evaluating surgical approaches for suspected appendicitis in pregnant patients is crucial for maternal and fetal well-being.

Purpose of the Study:

• To compare the safety and efficacy of laparoscopic versus open surgery for suspected appendicitis in pregnant patients.
• To assess the impact of surgical approach on maternal and fetal outcomes.

Main Methods:

• Retrospective review of 65 pregnant patients who underwent surgery for suspected appendicitis (1999-2008).
• Statistical analysis included Pearson's chi(2) test, Fisher's exact test, Mann-Whitney test, and Kruskal-Wallis test.
• Outcomes assessed included length of hospital stay, maternal mortality, and fetal outcomes (fetal loss, APGAR score, birth weight, preterm delivery).

Main Results:

• Laparoscopic surgery was favored in the first and second trimesters (100% and 73%, respectively).
• Open surgery was more frequent in the third trimester (71%).
• Laparoscopic surgery demonstrated a significantly shorter mean hospital stay (3.4 days vs. 4.2 days). No significant differences were observed in maternal mortality or fetal outcomes between the groups. Adverse outcomes were linked to maternal fever, leukocytosis, or delayed presentation.

Conclusions:

• Laparoscopy is a safe, feasible, and effective surgical approach for pregnant patients with presumed acute appendicitis.
• The underlying diagnosis and maternal factors, rather than the surgical approach, appear to be primary determinants of pregnancy complications.
• Laparoscopy offers a diagnostic advantage in identifying other intra-abdominal pathologies that may mimic appendicitis and pose risks during pregnancy.