Surgery in the pregnant patient

Edwards, Rodney K.; Bennett, Barbara B.; Ripley, Daylene; Simms-Cendan, Judith; Davis, John D.; Cendán, Juan; Stone, I.K.

doi:10.1067/msg.2001.112768

Cited by 15 publications

(47 citation statements)

References 126 publications

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“…However, in this context, we have to consider that, even in experienced hands, for macroscopic qualification of an adnexal mass the false-positive findings for malignancy were as high as 53% [21]. Additional to ultrasound, in case of uncertainty of the origin of the mass, pre-operative MRI can give additional information [22]. Determination of CA-125 as a predictor of ovarian malignancy is shown not to be useful in pregnancy [23], since its level is frequently elevated in normal pregnancy.…”

Section: Discussionmentioning

confidence: 93%

Laparoscopic management of adnexal masses with the open entry technique in second-trimester pregnancy

et al. 2004

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Background and Objectives: To describe laparoscopic management of adnexal mass during pregnancy between January 1994 and November 2003 and give an overview of existing literature on this subject (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003). Design: Observational (descriptive) study with prospectively collected database supplemented by retrospective chart review. Setting: Tertiary-care referral centre. Subjects: Eleven consecutive pregnant patients with an adnexal mass. Interventions: Ten patients had laparoscopy with the open entry technique and one with the closed entry technique. Main outcome measures: Blood loss, operating time, number of conversions to laparotomy, complications and pregnancy outcome. Results: The incidence of laparoscopic management of adnexal pathology during pregnancy in our institution was 1:1,206 pregnancies (0.1%). One patient was suspected to have an ovarian malignancy, which appeared to be a large malignant tumour originating from the intestine. Ovarian malignancy was not found. In seven cases, surgery was postponed until the 16th week of gestation; however, four patients required surgery earlier in pregnancy due to suspicion of ovarian malignancy (n=1) or adnexal torsion (n=3). No entry-related or intra-operative complications occurred. Two procedures were converted to laparotomy but were not due to laparoscopic complications. One intra-uterine foetal death occurred at 24 weeks of gestation (12 weeks after adnexal detorsion). No postoperative maternal complications occurred, and nine healthy infants were born. One patient continues to have an uncomplicated pregnancy. Conclusions: Adnexal masses requiring surgical intervention can be explored laparoscopically.We advise the open entry technique in order to avoid entry-related complications, e.g. to the pregnant woman's uterus and the adnexal mass.

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Section: Discussionmentioning

confidence: 93%

Laparoscopic management of adnexal masses with the open entry technique in second-trimester pregnancy

et al. 2004

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“…Los cálculos a nivel de la vesícula biliar se subdividen según su composición química, a saber: 75% colesterol, 25% pigmentos biliares 23,24,25 . El mecanismo básico en la producción de los cálculos es la sobresaturación de los componentes de la bilis que exceden su máxima solubilidad, además se asocia estasis biliar, cristales de calcio en la bilis y, ante la presencia de hipercolesterolemia, se inicia la formación de cálculos [26][27] . La mujer embarazada está sujeta a todas las enfermedades quirúrgicas de las mujeres no embarazadas y la patología de las vías biliares no es la excepción.…”

Section: Apendicitis Aguda En El Embarazounclassified

Surgical pathologies in pregnancy

Olmedo

Segovia

2016

Rev. Nac. (Itauguá)

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Introducción: una de cada 50 mujeres presentará durante su embarazo dolor abdominal potencialmente quirúrgico y una de cada 600 mujeres embarazadas requerirá de cirugía abdominal no obstétrica durante el embarazo. Objetivos: determinar la frecuencia y características demográficas y clínicas de patologías quirúrgicas durante el embarazo en pacientes internadas en el Hospital Nacional del año 2010 al 2014. Metodología: diseño observacional, descriptivo, retrospectivo de corte trasversal. Población estudiada: gestantes y/o puérperas atendidas en el Hospital Nacional con diagnóstico de patologías quirúrgicas durante los años 2010-2014. Muestreo no probabilístico según criterio. Resultados: se hallaron76 mujeres (0,5%) con patologías quirúrgicas, la edad media fue 27 ± 6,2 años. La litiasis vesicular y la apendicitis aguda fueron las más frecuentes. La media de edad gestacional fue 28 ± 9,4 semanas. Las complicaciones fueron abdomen agudo y pancreatitis aguda, requiriendo cirugía 39(51,3%) pacientes. Conclusiones: la frecuencia de patologías quirúrgicas fue menor al 1%, las patologías biliares y apendiculares fueron las más frecuentes.Palabras claves: apendicitis aguda, colecistitis aguda, pancreatitis aguda, embarazo. ABSTRACT Introduction:One in 50 women during pregnancy will potentially present surgical abdominal pain and one of every 600 pregnant women will require nonobstetric abdominal surgery during pregnancy. To determine the frequency and types of surgical pathologies during pregnancy in patients hospitalized in the National Hospital from 2010 to 2014. Methodology: observational, descriptive, retrospective study cross-sectional. Population studied pregnant and / or postpartum women treated at the National Hospital with a diagnosis of surgical pathologies during the years 2010-2014, no probabilistic sampling according to criteria. Results: 76 (0.5%) with surgical pathologies, median age were found: 27 ± 6.2 years, Cholelithiasis and acute appendicitis were the most frequent. Median gestational age was 28 ± 9.4 weeks. The complication were acute abdominal patology and acute pancreatitis, requiring surgery 39 (51.3%) patients. Conclusions: The frequency of surgical pathologies were less than 1%, biliary and appendicular pathology were the most frequent.

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“…Gleiches gilt für adipöse Patienten, bei denen die klinische Diagnostik erschwert und das Risiko postoperativer Wundinfektionen erhöht ist.Insbesondere für diese 2 Patientengruppen ließ sich eine deutliche Reduktion unnötiger Appendektomien bei konsequenter Anwendung der diagnostischen Laparoskopie nachweisen [10,41,42,65].Der geschilderte Vorteil einer sicheren Diagnostik sollte dementsprechend bei allen Patienten mit unklaren Unterbauchschmerzen ausgenutzt werden, um eine verzögerte Therapie bei prolongierter Diagnostik zu vermeiden. Dies kann auch bei dem Verdacht einer Appendizitis in der Schwangerschaft Anwendung finden, da hier mit fortschreitendem Entzündungsstadium der Verlauf für Mutter und Kind kritischer wird [9,11,46,639]. Die Schwangerschaft im 1. und 2.…”

Section: Diskussionunclassified

“…Die Schwangerschaft im 1. und 2. Trimester stellt keine Kontraindikation für ein laparoskopisches Vorgehen mehr dar [9,28,53,63].…”

Section: Diskussionunclassified

Offene vs. laparoskopische Appendektomie

Lippert

Koch

Marusch

et al. 2002

Chirurg

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This article discusses the question of whether open or laparoscopic appendectomy is preferable in today's clinical routine. The article is based on data from randomized studies, evaluation of meta-analyses, and data from nonrandomized, multicentric studies evaluating the treatment of appendicitis in routine clinical practice. According to the data analysis, open appendectomy (OA) offers advantages with regard to a significantly shorter operative time and lower hospital costs. Laparoscopic appendectomy (LA) is characterized by a significantly decreased rate of failed septic wound healing and faster recovery. Both procedures can be performed with the same degree of safety and comparable outcome for acute appendicitis. Laparoscopic appendectomy offers significant advantages for establishing a precise diagnosis in young fertile women and overweight patients suffering from lower abdominal pain. The currently available data do not provide precise guidelines for the treatment of perforating appendicitis. However, we found significant evidence indicating an increased rate of postoperative intra-abdominal abscess after laparoscopic appendectomy. Thus, a laparoscopic approach cannot be regarded as a standard technique in advanced appendicitis.

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Surgery in the pregnant patient

Cited by 15 publications

References 126 publications

Laparoscopic management of adnexal masses with the open entry technique in second-trimester pregnancy

Laparoscopic management of adnexal masses with the open entry technique in second-trimester pregnancy

Surgical pathologies in pregnancy

Offene vs. laparoskopische Appendektomie

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