Open versus laparoscopic appendectomy for acute appendicitis in pregnancy: a population-based study

Area of Science:

• Obstetrics and Gynecology
• General Surgery
• Surgical Outcomes Research

Background:

• Acute appendicitis (AA) in pregnancy presents unique challenges.
• The safety and efficacy of laparoscopic appendectomy (LA) versus open appendectomy (OA) in pregnant patients remain debated.
• Understanding comparative outcomes is crucial for clinical decision-making during pregnancy.

Purpose of the Study:

• To compare surgical and obstetrical outcomes between LA and OA for acute appendicitis in pregnant women.
• To evaluate the safety and effectiveness of minimally invasive surgery in this population.
• To provide evidence-based recommendations for managing appendicitis during pregnancy.

Main Methods:

• Retrospective review of a nationwide claim-based database in Estonia (2010-2020).
• Inclusion of pregnant women diagnosed with acute appendicitis who underwent either OA or LA.
• Analysis of primary obstetrical outcomes (preterm delivery, fetal loss, perinatal mortality) and secondary surgical outcomes (operative time, hospital length of stay, postoperative complications).

Main Results:

• A total of 102 pregnant patients were analyzed (68 OA, 34 LA).
• Laparoscopic appendectomy (LA) demonstrated significantly shorter operative times (34 min vs. 44 min) and hospital length of stay (2.1 days vs. 2.9 days) compared to open appendectomy (OA).
• No significant differences were observed in surgical complications or key obstetrical outcomes (preterm delivery, fetal loss, perinatal mortality) between the LA and OA groups.

Conclusions:

• Laparoscopic appendectomy for acute appendicitis in pregnancy is associated with reduced operative time and hospital stay.
• The study supports the safety of LA during pregnancy, showing comparable obstetrical outcomes to OA.
• Findings advocate for the consideration of laparoscopic appendectomy as a viable and beneficial approach for managing acute appendicitis in pregnant individuals.