Publication:

Evaluation of safety and efficacy of laparoscopic appendectomy during pregnancy

Background Optimal surgical approach for appendectomy during pregnancy remains controversial. The objective of this study is to evaluate (LA) during pregnancy as regard safety and outcome compared with open appendectomy (OA).

Methods Patients with acute appendicitis during pregnancy who were admitted to Sohag University Hospital from August 2014 to April 2018 were randomized to 2 groups: Group A (OA, 22 patients) and group B (LA, 20 patients). The primary end point was incidence of fetal loss. Secondary endpoints comprised preterm delivery, operative time, length of hospital stay, conversion rate and surgical complications.

Results Forty-two patients were enrolled after exclusion of three cases due to severe cardiac disease. Fourteen patients (33.3%) presented during first trimester 7 patients per group, 19 (45.2%) during second trimester 10 in group A (23.8%) and 9 in group B (21.4%) and 9 (21.4%) during third trimester 5 in group A (11.9%) and 4 in group B (9.5%). Mean maternal age was 22.3±4.2 (range, 18-38) years in group A and 21.3±3.6 (range, 17-35) years in group B. Fetal loss occurred in one patient in group A (4.5%) and in 2 patients in group B (10%). No pre-term delivery occurred in either group. Operative time was slightly longer in group A (mean op. time was 42±12 min vs. 40±11min) than in Group B. No intra operative complications occurred in either group. Hospital stay was significantly shorter in group A (1.2±1.8 days) while it was (3.6±1.1days) in group B. Wound infection occurred in two patients (10%) in group B while no post-operative complications occurred in group A.

Conclusions Forty-two patients were enrolled after exclusion of three cases due to severe cardiac disease. Fourteen patients (33.3%) presented during first trimester 7 patients per group, 19 (45.2%) during second trimester 10 in group A (23.8%) and 9 in group B (21.4%) and 9 (21.4%) during third trimester 5 in group A (11.9%) and 4 in group B (9.5%). Mean maternal age was 22.3±4.2 (range, 18-38) years in group A and 21.3±3.6 (range, 17-35) years in group B. Fetal loss occurred in one patient in group A (4.5%) and in 2 patients in group B (10%). No pre-term delivery occurred in either group. Operative time was slightly longer in group A (mean op. time was 42±12 min vs. 40±11min) than in Group B. No intra operative complications occurred in either group. Hospital stay was significantly shorter in group A (1.2±1.8 days) while it was (3.6±1.1days) in group B. Wound infection occurred in two patients (10%) in group B while no post-operative complications occurred in group A.