The laparoscopic management of appendicitis and cholelithiasis during pregnancy

Affleck, David G.; Handrahan, Diana; Egger, Marlene J.; Price, Raymond R.

doi:10.1016/s0002-9610(99)00244-5

Cited by 187 publications

(127 citation statements)

References 17 publications

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“…Discussion Nonobstetrical surgery during pregnancy was shown to be safe in a study over 5,405 operations on pregnant women without increases of congenital malformations or stillbirths, but with higher incidences of very-low, low-birth-weight infants, and death of infant during the first 168 days [17,18]. The laparoscopic procedure was safely performed in pregnant females in several published studies [2,13,19,20], although the gravid condition has long been seen as a contraindication for laparoscopic surgical procedures [21]. Concerns included teratogenicity in the first trimester and preterm delivery during the second and third trimester.…”

Section: Resultsmentioning

confidence: 97%

Laparoscopic management of appendicitis and symptomatic cholelithiasis during pregnancy

Halkic

Tempia-Caliera

Ksontini

et al. 2006

Langenbecks Arch Surg

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Background Laparoscopic surgery during pregnancy is a challenging procedure that most surgeons are reluctant to perform. The objective of this study was to evaluate whether laparoscopic appendectomy and cholecystectomy is safe in pregnant women. The management of these situations remains controversial. We report a single center study describing the successful management of 16 patients during pregnancy. Methods More than 3,356 laparoscopic procedures were performed in our institutions between May 1990 and June 2005. Sixteen of these patients were operated on in the second and third trimester between 22 and 32 weeks of estimated gestational age. We performed 11 laparoscopic appendectomies and 5 laparoscopic cholecystectomies. We also reviewed the management and operative technique used in these patients. Results In this study, the laparoscopic appendectomy or cholecystectomy was performed successfully in all patients. Three patients were in their second trimester, weeks 22, 23, and 25, and 13 were in the third trimester, weeks 27 (three patients), 28 (five patients), 31 (three patients), and 32 (two patients). No maternal or fetal morbidity occurred. Open laparoscopy was performed safely in all patients and all patients delivered healthy babies.Conclusion From our experience laparoscopic management of appendicitis and biliary colic during pregnancy is safe, however the second trimester is preferable for laparoscopic cholecystectomy. Pregnancy is not a contraindication to the laparoscopic approach to appendicitis or symptomatic cholelithiasis. We believe that laparoscopic operations, when performed by experienced surgeons, are safe and even preferable for the mother and the fetus.

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Section: Resultsmentioning

confidence: 97%

Laparoscopic management of appendicitis and symptomatic cholelithiasis during pregnancy

Halkic

Tempia-Caliera

Ksontini

et al. 2006

Langenbecks Arch Surg

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“…3,[51][52][53][54][55][56][57][58][59][60][61][62] Although long-term data on the safety and efficacy of laparoscopic appendectomy during pregnancy are limited, meta-analyzes of observational studies, including a total of more than 500 laparoscopic appendectomies, have shown an increase in the fetal loss rate with this approach, when compared with open appendectomy. 63,64 In a 2012 meta-analysis (11 studies, 3,415 women, 599 in the laparoscopic and 2,816 in the open group), the total relative risk of fetal loss for laparoscopic appendectomy against open surgery in pregnant women was OR 1.91, 95% CI 1.31 to 2.77%.…”

mentioning

confidence: 99%

Acute appendicitis in pregnancy: literature review

Neto

Amorim²,

Nóbrega³

2015

Rev. Assoc. Med. Bras.

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Conflict of interest: noneIntroduction: suspected appendicitis is the most common indication for surgery in non-obstetric conditions during pregnancy and occurs in about one in 500 to one in 635 pregnancies per year. This occurs more often in the second trimester of pregnancy. Acute appendicitis is the most common general surgical problem encountered during pregnancy. Methods: a literature review on research of scientific articles, under the terms "acute appendicitis" and "pregnancy", in PubMed, Lilacs/SciELO, Scopus, Cochrane Library and Uptodate databases.Results: the clinical manifestations of appendicitis are similar to non-pregnant women, however, without a classic presentation, which often occurs, diagnosis is difficult and must be supported by imaging. Discussion: clinical diagnosis should be strongly suspected in pregnant women with classic findings such as abdominal pain that migrates to the right lower quadrant. The main purpose of imaging is to reduce delays in surgical intervention due to diagnostic uncertainty. A secondary objective is to reduce, but not eliminate, the negative appendectomy rate. Differential diagnosis of suspected acute appendicitis usually includes pathologies considered in non-pregnant people. Conclusion: the imaging study of choice is ultrasound, MRI may be used when the former is not conclusive and, as a last resort, a CT scan can be performed. The treatment remains appendectomy by laparotomy, since the feasibility of video-assisted surgery in these cases remains controversial.

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“…В рекоменда-циях SAGES с уровнем доказательности IIВ гово-рится, что лапароскопия и лапароскопическая ап-пендэктомия (ЛА) безопасны у беременных пациен-ток в любом триместре беременности и может быть у них стандартом при подозрении на острый аппен-дицит [14]. Эта рекомендация основана на 3 иссле-дованиях, в которых была выполнена 41 ЛА у бере-менных женщин [8,10,11]. Какой-либо значимой разницы оцениваемых параметров по сравнению с открытой операцией получено не было: 2 случая вы-кидыша после ЛА при отсутствии выкидышей в группах традиционной аппендэктомии были при-знаны статистически незначимыми.…”

Section: результаты и обсуждениеunclassified