Abdominal surgery in pregnancy--an interdisciplinary challenge

Area of Science:

• Obstetrics and Gynecology
• Surgical Innovation
• Maternal-Fetal Medicine

Background:

• Abdominal operations occur in approximately 2% of pregnancies, presenting unique challenges for patients and medical teams.
• Appendectomy and cholecystectomy are the most frequent surgical procedures during gestation.
• Optimal peri- and intraoperative management and surgical approaches require careful consideration.

Purpose of the Study:

• To review and compare the safety and outcomes of laparoscopic versus laparotomy approaches for abdominal surgery during pregnancy.
• To analyze the risks of miscarriage and preterm birth associated with different surgical methods in pregnant patients.

Main Methods:

• A selective literature search was conducted in the PubMed database.
• Pertinent articles were retrieved and analyzed to synthesize findings on surgical approaches during pregnancy.

Main Results:

• Laparoscopic appendectomy is associated with a significantly higher miscarriage rate compared to open appendectomy (RR 1.91).
• Preterm birth risks vary, with some studies indicating higher rates after laparoscopic appendectomy, while others show lower rates.
• For cholecystectomy, laparoscopy had a lower miscarriage rate but a somewhat higher preterm birth rate than laparotomy.
• Delaying or withholding surgery for appendicitis or cholecystitis can increase adverse pregnancy outcomes.

Conclusions:

• Laparoscopic surgery, when performed by experienced surgeons, is safe during pregnancy, offering minimally invasive advantages.
• Despite its benefits, laparoscopy carries a higher miscarriage rate than laparotomy, with comparable preterm birth rates.
• Informed consent is crucial, ensuring patients understand the pros and cons of each surgical approach before undergoing procedures.