Laparoscopic appendectomy in pregnancy

Summary Since 1982 we have operated on more than 150 patients using the laparoscopic appendectomy technique. Our complication rate was 0.75% and the patients included six pregnant women in all stages of pregnancy. There were no complications in this group of six women.Based on a presentation to the XII World Congress of Gynecology and Obstetrics, Rio de Janeiro 1988     

Laparoscopic appendectomy in pregnancy

BACKGROUND: Acute appendicitis is the most common cause of an acute abdomen in pregnancy. However, due to the potential fetal risk associated with the CO2-pneumoperitoneum and various operative technical reasons there is still controversy about the role of laparoscopic appendectomy in pregnant women. PATIENTS AND METHODS: Between January 2000 and November 2005, 283 women between 17 and 45 years with suspected appendicitis underwent laparoscopic appendectomy at our institution. Fifteen of these patients (5.3 %) were pregnant at the time of surgery (mean age, 28 years; range, 18-40 years; mean gestational age, 21.9 weeks; range, 14-34 weeks). Perioperative obstetric monitoring included fetal ultrasound, including Doppler sonography and cardiotocography. Clinical data were collected prospectively. Complete follow-up data were available in 14 patients. RESULTS: All 15 patients underwent successful laparoscopic appendectomy. Mean operation time was 53 minutes (range, 30-100 minutes). The histologic appendicitis / appendectomy ratio was 73 %. One patient showed a postoperative pyelonephritis, another a cystitis. Average length of hospital stay was 5.5 days (range, 3-10 days). All fourteen pregnancies with complete follow-up resulted in delivery of healthy infants. The mean gestational age at delivery was 39.6 weeks (range, 35-42 weeks). Two patients (14.3 %) had a preterm delivery at 35 weeks with uncomplicated outcome. One patient underwent caesarean section at 41 weeks after chorioamnionitis. CONCLUSIONS: Laparoscopic appendectomy is a safe and effective method to treat acute appendicitis in pregnant women regardless of the trimester. For the best outcome the operation should be performed in a center where surgeons, perinatologist, obstetricians and anesthesiologists work together as a part of an interdisciplinary team.     

Laparoscopic appendectomy during pregnancy

Appendectomy is the most common nonobstetric operation during pregnancy, but laparoscopy has not been considered to be the preferred procedure until recently. The objective of this study was to report the authors' experience with laparoscopic appendectomy during pregnancy and to review the available literature. Six patients underwent laparoscopic appendectomy during pregnancy, and 24 additional cases from the literature were reviewed. Two patients underwent surgery during the first trimester of pregnancy, three patients underwent surgery during the second trimester, and one patient underwent surgery during the third trimester. The Hasson open technique was used in five cases, and the Veress needle was used in one case. Port site locations were adapted to the size of the gravid uterus. Three patients had histologically confirmed appendicitis and underwent delivery of a neonate after 36 weeks (n = 1) and 37 weeks (n = 2) of gestation. Two patients had uterine infections and underwent abortions 2 days after surgery and 6 weeks after surgery, respectively. One patient had an isolated torsion of the right fallopian tube that was diagnosed using laparoscopy. These results show that laparoscopic appendectomy can be safely performed during pregnancy. One limitation may be the size of the gravid uterus, which interferes with adequate visualization and instrumentation in the third trimester of pregnancy.     

Laparoscopic appendectomy versus open appendectomy in pregnancy: a population-based analysis of maternal outcome

Background

Laparoscopic appendectomy (LA) is the standard treatment of acute appendicitis for the general population; however, there is still some doubt regarding its safety for pregnant patients. Therefore, the purpose of this study is to investigate and compare the maternal outcome of pregnant patients with acute appendicitis following either an open appendectomy (OA) or LA from a population-based database.

Methods

This study is based on the National Health Insurance Research Database. Patients with both ICD-9-CM codes for appendicitis (540.9, 540.0, and 540.1) and pregnancy (V22) in the same admission were considered to have acute appendicitis during pregnancy. These patients were divided into three groups according to the type of treatment: LA, OA, and non-operative treatment. Outcome measures that were compared between the groups included maternal complications such as preterm labor, abortion, and the need of cesarean section. Besides, the differences of medical expenditure and length of hospital stay between the groups were also analyzed.

Results

From 2005 to 2010, a total of 859 pregnant women who had acute appendicitis were identified. They had increased risks for preterm labor, abortion, and increased requirement of cesarean section compared to the control group (i.e., those without acute appendicitis). Among the three groups, the non-operated group has the highest risk of preterm labor. Patients who underwent LA did not have any increased risk of maternal complications compared to the OA group. Furthermore, LA patients had shorter hospital stay than OA.

Conclusion

Compared to non-operative treatment, appendectomy is the preferred treatment for pregnant patients who have acute appendicitis. LA can be performed safely in pregnant patients without bringing additional maternal complications compared to OA.

     

Laparoscopic appendectomy

Most laparoscopic procedures are performed on an elective basis. However, as general surgeons have gained more experience with laparoscopy, they are employing this procedure also for the evaluation and treatment of acute abdominal conditions such acute appendicitis, acute cholecystitis, perforated gastroduodenal ulcer and abdominal trauma, acute pancreatitis and intestinal obstruction. Although its advantages are still under debate, the laparoscopic approach has already been adopted by many centers in the emergency setting.     

Laparoscopic appendectomy

Appendectomy was performed using a laparoscopic approach in 915 patients. The collected data show that the technique is as feasible, rapid, and safe as open surgery. Few wound infections, minimal pain, and rapid postoperative mobilization are the main arguments in favor of laparoscopic appendectomy. The most important potential benefit, a lower incidence of long-term complications such as adhesive intestinal obstruction, remains to be confirmed by prolonged follow-up of our patients.

---

Resumen En este articulo describimos la apendicetomía por abordaje laparoscópico e informamos los resultados en 915 operaciones practicados por esta modalidad. Los datos indican que la nueva técnica es factible, rápida y segura, tanto como la cirugía abierta. Escasas infecciones de herida, mínimo dolor y pronta movilización postoperatoria son los argumentas principales a favor de la apendicectomía laparoscópica. El beneficio de mayor importancia potencial, una menor incidencia de complicaciones tardías, taíes como obstrucción intestinal por adherencias, debe ser confirmada por el seguimiento a largo plazo de nuestros pacientes.

---

Résumé Nous décrivons l'appendicectomie par coelioscopie pratiquée chez 915 patients. Les résultats indiquent que cette technique est aussi efficace, rapide et sûre que l'appendicectomie traditionnelle. Un taux moindre d'infections pariétales, un minimum de douleur et une récupération postopératoire rapide sont les arguments principaux en faveur de l'appendicectomie coelioscopique. L'atout majeur qui paraÎt Être la basse incidence de complications à long-terme telle que les adhérences, éventuelle source d'occlusion intestinale, reste cependant à évaluer.

     

Laparoscopic stapler appendectomy

Background: The value of laparoscopic appendectomy remains controversial. Therefore, we investigated the accuracy of diagnostic laparoscopy in detecting acute appendicitis and tested the applicability and safety of stapling appendectomy as a routine procedure. Methods: Data from 267 consecutive patients with suspicion of acute appendicitis were recorded prospectively. Results: Histopathological examination revealed nonperforated and perforated appendicitis in 63.3% and 13.1%, respectively, and no inflammation in 10.8%. Other pathological findings were observed in 12.7%. Diagnostic laparoscopy detected appendicitis with a sensitivity and specificity of 95.6% and 96.6%, respectively; the positive and negative predictive value were 99.5% and 74.3%, respectively. Morbidity was 10.2% in total and 40% for perforated appendicitis. Planned laparoscopic reexploration reduced morbidity by 23.4% in patients with perforated appendicitis and substantial peritonitis. Mortality was 0.4%. Conclusions: Laparoscopy improves diagnostic accuracy for acute appendicitis and laparoscopic stapling appendectomy is a safe and efficient procedure for all forms of appendicitis.     

Laparoscopic appendectomy.

In October 1989 the author began a study of laparoscopic appendectomy. This paper presents the preliminary results in 21 patients. Laparoscopy was carried out for diagnosis and 12 patients underwent laparoscopic appendectomy. The morbidity, length of hospital stay and time lost from work was reduced in all 12 patients. The author describes the technique of laparoscopic appendectomy and recommends that only experienced laparoscopists should carry out this procedure.     

Laparoscopic appendectomy.

This study contains a brief review of the changes in the technique of laparoscopic appendectomy. The authors' experiences with the methods they applied are reported. The authors emphasize on the benefits of laparoscopic appendectomy as opposed to traditional appendectomy, and advocate its wide-range application.     

Laparoscopic appendectomy in pregnancy: a case series of seven patients.

BACKGROUND: Appendicitis in the pregnant patient presents with diagnostic difficulties and more serious problems. Open surgery has its own limitations, mostly governed by the stage of the disease and the trimester of pregnancy. Laparoscopic appendectomy is beginning to be recognized as standard appendicitis treatment, as evidenced by several studies. In pregnancy, laparoscopy is even more controversial. Several studies prove the safety of laparoscopy and some studies disprove it. METHODS: We have treated 7 patients in the last 10 years; 6 had acute appendicitis and 1 had a perforated appendix. Ultrasound diagnosed 5 patients, and CT scan identified the other 2 patients. The patient with the perforated appendix had free fluid in the right iliac fossa and pelvis. Laparoscopic appendectomy was done in all patients. DISCUSSION: Pregnancy poses its own unique problems to the surgeon and anesthesiologist. The normal physiology becomes altered, and sound knowledge of this is necessary to handle these patients. Clinical presentation was mostly straightforward. Both ultrasound and CT scan were useful investigations. CONCLUSION: Most studies support the use of laparoscopy in the management of appendicitis. There was no mortality (for mother and fetus) or morbidity in our patients.     

Laparoscopic appendectomy during pregnancy: between personal experiences and scientific evidence

BACKGROUND: Although laparoscopic appendectomy is a safe and effective procedure for management of acute appendicitis, data about the feasibility and safety during pregnancy are limited. We aimed to study our experience in this field and to review the scientific evidence available. STUDY DESIGN: All patients undergoing laparoscopic appendectomy during pregnancy, from January 2003 to December 2005, were included. Medical files were reviewed retrospectively. In addition, 133 cases from the literature were reviewed. General features of the cases, surgical technique details, and outcomes were analyzed. RESULTS: All laparoscopic procedures were completed without conversion to open operation. No substantial hemodynamic or gasometric changes were detected during the procedures. Tocolytic medication was not administered in any patient. All patients were discharged from hospital within the first 48 postoperative hours, and no complications were recorded during this period or in the followup. All newborns had an adequate weight for gestational age, satisfactory parameters of well-being at birth, and an uneventful development after 1-year followup. CONCLUSIONS: Laparoscopic appendectomy during pregnancy is as effective and safe as the conventional approach and has all the benefits of minimally invasive operation, provided that specific recommendations for these types of patients are strictly followed. It must be mentioned that there is only limited scientific evidence to support this statement.     

腹腔镜阑尾切除术在妊娠合并阑尾炎治疗中的疗效及安全性分析

目的:探讨腹腔镜阑尾切除术用于妊娠合并阑尾炎治疗中的疗效及安全性。方法:回顾分析2013~2015年妊娠期小于7个月合并阑尾炎的38例患者的临床资料,其中17例行腹腔镜手术(腔镜组),21例行开腹手术(开放组)。对比分析两种术式的有效性与安全性。结果:腔镜组腹腔残余感染率为5.88%,未发生切口感染;开放组残余感染发生率为38.0%,切口感染率为33.3%;腔镜组感染发生率、切口感染率明显优于开放组(P0.05)。腔镜组切口均小于1.5 cm,开放组切口为5 cm;腔镜组手术时间平均(35.26±3.87)min,开放组平均(51.26±7.87)min;腔镜组平均住院(3.43±0.78)d,开放组平均(5.68±1.52)d,腔镜组手术切口长度、手术时间、住院时间均优于开放组(P0.05)。术后随访38例患者,均正常分娩。结论:妊娠早中期合并阑尾炎行腹腔镜手术是安全的,具有手术时间短、切口小、住院时间短、手术并发症少的优点。     

Laparoscopic appendectomy in the elderly

Background This study aimed to compare the outcomes of laparoscopic and open appendectomy among the elderly. Methods Data on 53 elderly patients with a diagnosis of suspected appendicitis were prospectively collected and retrospectively reviewed. Among these patients, 24 had undergone laparoscopic appendectomy (LA) and 29 had undergone open appendectomy (OA). The indications for either method were based on the patient’s choice. Results No statistically significant difference in operative time was found between the LA (70 ± 28 min) and OA (60 ± 22 min) groups. There was no statistically significant difference in lengths of hospital stay between the LA (4.8 ± 3.0 days) and OA (5.0 ± 3.1 days) groups, and there was a statistically significant difference in the postoperative analgesic doses between the LA (0.5 ± 0.3 doses) and OA (1.7 ± 1.5 doses) groups. No conversion of laparoscopic to open surgery was necessary, and no intraabdominal abscesses developed. Conclusion According to this study, LA is as safe and effective as OA for the elderly. Furthermore, it significantly reduces postoperative wound pain.     

Laparoscopic appendectomy in the elderly

BACKGROUND: Evidence suggests that laparoscopic appendectomy (LA) has advantages over open appendectomy (OA) in the treatment of appendicitis. It remains, however, unclear whether LA is indicated in the elderly patient population. METHODS: Patients with primary International Classification of Diseases, revision 9, procedure codes for LA (n=32406 patients) and OA (n=112884 patients) were selected from the 1998, 1999, and 2000 Nationwide Inpatient Samples. The end points that were under investigation were the length of hospital stay, the rate of routine discharge, and in-hospital morbidity and mortality rates. Multiple linear and logistic regression analyses were performed to assess the risk-adjusted association between the surgery type and the patient outcomes. Stratified analyses were performed according to age (65 years and older; less than 65 years old) and to the presence of appendiceal perforation or abscess. RESULTS: After risk adjustment, patients who underwent LA had a significantly shorter mean length of stay (LA, 2.45 days; OA, 3.71 days; P <. 0001), higher rate of routine discharge (odds ratio, 2.80; P <.0001), lower overall complication rate (odds ratio, 0.92; P=.03), and mortality rate (odds ratio, 0.23; P=.001) compared with OA patients. Similar benefits of LA were found in the strata of patients who were less than 65 years old, in elderly patients, and in patients with appendiceal perforation or abscess. CONCLUSION: LA has statistically significant advantages over OA with respect to the length of hospital stay, the rate of routine discharge, and postoperative morbidity and mortality rates for patients who are less than 65 years old, in elderly patients, and in patients with appendiceal abscess or perforation.