Safety of laparoscopic appendicectomy during pregnancy: a systematic review and meta‐analysis

Abstract

Background Acute appendicitis is the most common non‐obstetric surgical presentation during pregnancy. There were concerns that laparoscopic appendicectomy increases the risk of foetal loss compared to an open approach. Therefore, with recent advances in perioperative care, it is likely the risk has changed. Here, we performed an updated meta‐analysis assessing the safety of laparoscopic appendicectomy in pregnant women. Methods A meta‐analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A search was undertaken between 2000 and 2017 on Ovid Medline and Embase. The primary outcome measures were foetal loss and preterm delivery, whereas secondary outcome measures were operative time and hospital length of stay. A random‐effect model was performed to pool odds ratio (OR) and standardized mean difference (SMD). Results Seventeen observational studies were included, with 1886 patients in the laparoscopic and 4261 patients in the open group. Comparing laparoscopic versus open appendicectomy, there were 54 (5.96%) and 136 (3.73%) foetal losses, respectively. However, preterm delivery was much higher in the open approach (8.99%) compared to laparoscopic approach (2.84%). Pooled OR for foetal loss was 1.84 (95% confidence interval (CI) 1.31–2.58, P < 0.001), whereas OR for preterm delivery was 0.39 (95% CI 0.27–0.55, P < 0.001). There was no significant difference between both approaches for operative time (SMD −0.07; 95% CI −0.43 to 0.30, P = 0.71) or hospital length of stay (SMD −0.34; 95% CI −0.83 to 0.16, P = 0.18). Conclusion In a pooled analysis of level III evidence, laparoscopic appendicectomy posed a higher risk of foetal loss but lower risk of preterm delivery. Caution and informed consent are crucial when offering a laparoscopic approach.

Updated Evaluation of Laparoscopic vs. Open Appendicectomy During Pregnancy: A Systematic Review and Meta-Analysis

“…Nowadays, there is deficient testimony to point out the optimal operation of appendicitis in pregnancy because large RCTs are difficult to conduct in pregnant women. In recent years, systematic reviews and meta-analyses also had no consensus on whether to choose LA or OA (15)(16)(17). Under such an unclear situation, further explorations for pregnant appendicitis are necessary.…”

“…However, in clinical practice, LA and OA both have been performed in patients, whether it is the early or the third trimester. Many systematic reviews have been published to evaluate the effects of the two surgical methods on the fetus and pregnant women, but until now there have been no consistent conclusions (15)(16)(17). In the past 2 years, some clinical studies evaluating the two operations have tended to show no significant difference in obstetric outcomes, such as fetal loss and pre-term delivery (18,19).…”

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

“…The most frequent indications for surgery during pregnancy are infections such as acute appendicitis and cholecystitis [5][6][7][8][9][10][11][12][13][14]; pregnant women may also require acute surgical intervention for ovarian disorders and bowel obstruction, as well as for traumatological or oncological indications [11]. Any kind of pathology can occur in pregnant women and require immediate surgical treatment and optimized interdisciplinary management to achieve maximum safety for both mother and fetus, to avoid teratogenous medication, fetal acidosis and hypoxemia, and adverse pregnancy outcomes such as miscarriage, stillbirth or premature birth [4,8].…”

Analysis of 190 Female Patients after Appendectomy

“…Similarly, there have been no deaths [ 8 , 17 , 18 , 31 , 32 ]. On the contrary, a meta-analysis of 17 observational studies showed that LA had a higher risk of fetal loss (5.69% vs. 3.73%) but a low preterm delivery (2.84% vs. 8.99%) [ 40 ]. Nearly one out of twenty women who underwent appendectomy can have a complicated obstetrics course in the form of preterm labor, cervical incompetence, vaginal infection, and sepsis [ 41 ].…”