Laparoscopic appendectomy during pregnancy - a comparative study

The use of a minimally invasive approach to appendicitis in women of childbearing age has yet to be universally accepted. Laparoscopic appendectomy (LA) in pregnancy remains controversial due to the risk of maternal and fetal morbidity. The objectives were to evaluate and compare the postoperative complications of the procedure in pregnant and non-pregnant women, including pregnancy outcome. A retrospective review of all women within fertility age (pregnant and non-pregnant) who underwent LA for suspected acute appendicitis between January 2000 and December 2008 was conducted. Preoperative data, surgery and pathology results, intraand post-operative and obstetrical complications, and outcomes of pregnancy were analyzed and compared. 227 consecutive LA for clinically suspected acute appendicitis in women of childbearing age were performed during the study period. These included 24 (10.6%) pregnant women with mean gestation age of 12.2 weeks. There was no difference in occurrence of complicated appendicitis between groups; however, normal appendix was found significantly more frequently in the non-pregnant group (27 vs. 13%). Surgery time was significantly shorter in pregnant patients (30 vs. 36 minutes). There was no difference in length of postoperative stay and rate of postoperative complications between groups. The mean delivery age was 39.3 weeks (range 37- 41 weeks). Following LA six women were admitted for treatment of premature contractions during the third trimester of their pregnancy. One missed abortion due to partial mole was observed 9 weeks after surgery. LA is a safe and effective method for treatment of acute appendicitis during pregnancy and has all the benefits of a minimally invasive procedure, even in comparison to non-pregnant women. For the best outcome the operation should be performed by experienced laparoscopic surgeons.