Laparoscopic appendectomy with left lateral tilt in pregnant women in the second and third trimesters: A clinical case series in a single Vietnam centre

Abstract

Introduction: The presentation of acute appendicitis during pregnancy may cause diagnostic and therapeutic difficulty. Laparoscopic appendectomy (LA) is widely accepted as a minimally invasive procedure for acute appendicitis. However, LA during the second and third trimesters is associated with problems, including technical difficulty, a risk of foetal loss and preterm delivery. Method: Clinical data were retrospectively collected and analysed between April 2016 and April 2021. A telephone questionnaire was administered in cases of missing data. The clinical information obtained included a detailed medical and obstetric history; preoperative, intraoperative, and postoperative data; complications; and pregnancy outcomes. Results: There were a total of eighteen patients in the 2nd and 3rd trimesters who had undergone emergent laparoscopic appendectomy with a left lateral tilt of 70–90°. The gestational age at the time of surgery ranged from 20 to 35 weeks. The time to complete the first trocar for the camera ranged from 3 to 6 min, the operation time ranged from 30 to 60 min, and the length of hospital stay was 2–8 days. There were 5 procedures performed in the 3rd trimester. None of the cases required conversion to an open procedure, and all were without postoperative complications. Only one miscarriage complication was reported among a total of 4 patients with peritonitis. Conclusion: Our results demonstrated that urgent laparoscopic surgeries are feasible and can be safely performed with minimal risk for patients and foetuses in the second and third trimesters of pregnancy. Larger prospective studies are required to validate these findings. Highlights