Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies

Abstract

Introduction Acute appendicitis is a common and serious situation during pregnancy, because of the increased risk of fetal loss and perforation in the third trimester, as well as a diagnostic difficulty. During recent years laparoscopic approach has been introduced to clinical practice with encouraging results. The purpose of this meta-analysis is to compare the surgical and obstetrical outcomes between laparoscopic and open appendectomy during pregnancy. Materials and methods MEDLINE, SCOPUS, Clinicaltrials.gov, CENTRAL and Google Scholar were searched for studies reporting on postoperative outcomes between laparoscopic and open appendectomy during pregnancy. The random effects model (DerSimonian–Laird) was used to calculate pooled effect estimates when high heterogeneity was encountered, otherwise the fixed-effects (Mantel–Haenszel) model was implemented. Results Twenty-one studies that enrolled 6276 pregnant women are included in the present meta-analysis. Of these women, 1963 underwent laparoscopic appendectomy and 4313 underwent an open appendectomy. Women who underwent laparoscopic appendectomy demonstrated an increase in fetal loss risk, while neonates of women that underwent open appendectomy presented decreased Apgar score at five minutes after birth. All the rest outcomes were similar between the two groups. The time that each study took place seemed to affect the comparison of birth weight and postoperative hospital stay between the two groups. Conclusion Laparoscopic appendectomy seems to be a relatively safe therapeutic option in pregnancy when it is indicated. Thus, it should be implemented in clinical practice, always considering the experience of the surgeon in such procedures. Nevertheless, the need of new studies to enhance this statement remains crucial.

Non-obstetric surgery during pregnancy – an eleven-year retrospective analysis

“…The second most common reason for surgical intervention during pregnancy in our study was adnexal pathology, including one case of pediculated leiomyoma, the third was cholecystolithiasis [17][18][19][20][21][22][23][24][25].…”

Diagnosis, Management and Clinicopathological Features of Acute Appendicitis in Pregnant Women and Its Impact on Fetal Outcomes

“…Currently, the main surgical technique in the management of acute appendicitis during pregnancy is yet to be established. The preferred surgical method is based upon the trimester of pregnancy and the surgeon's own preference (3,9,13,24). Our findings indicated that the laparoscopic management of appendicitis was more frequently used in the non-pregnant women than in the pregnant women.…”

Apendicitis u trudnoći

“…Učestalost je približno jednaka kod trudnica te kod žena koje nisu trudne, a bolest se pojavljuje u otprilike 1/1500 trudnoća, što predstavlja 25 % neopstetričkih zahvata u trudnica. 1 Učestalost varira i tijekom same trudnoće, a pojavnost je u većini slučajeva u drugom tromjesečju. Unatoč činjenici da je akutna upala crvuljka češća tijekom prvog i drugog trimestra, perforacija i pojava komplikacija češće su u trećem trimestru.…”

“…UVOD Upala crvuljka jedna je od najčešćih operacija provođenih na odjelima kirurgije uopće s incidencijom koja varira od 100 do preko 150 slučajeva na 100 000 stanovnika, ovisno o tehnološkoj razvijenosti i geolokalizaciji populacije 1 . U trudnoći apendicitis predstavlja jednu od učestalih neopstetričkih hitnoća.…”