Outcomes and feasibility of laparoscopic appendectomy for complicated appendicitis in pregnancy

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Abstract

Background
Acute appendicitis (AA) is considered the most frequent nonobstetric, nongynecologic surgical disease during pregnancy. Laparoscopic appendectomy (LA) is safe and feasible for complicated appendicitis in adults, whereas the role of laparoscopy in complicated AA during pregnancy is not identified.
Aim
This study aimed to assess perioperative surgical and obstetrical outcomes of LA in pregnant women with complicated AA.
Patients and methods
This retrospective cohort study enrolled 19 pregnant women who underwent LA for AA during any trimester of pregnancy and were found to have complicated appendicitis that was defined intraoperatively as perforation of the appendix, gangrene, empyema, phlegmon, or abscess formation. A laparoscopic three-port technique was used. All patients were followed up at the outpatient clinic on postoperative days 7 and 14. Operative and postoperative surgical and obstetric outcomes were recorded.
Results
The mean age of the studied patients was 35.9 ± 6.6 years, and the mean gestational age was 20.9 ± 5.2 weeks. The mean operative time was 63.6 ± 8.0 min, and conversion to open surgery was not needed in any case. Postoperative surgical complications were infected supraumbilical wound and intra-abdominal subhepatic localized abscess formation (5.3% each). Obstetric complications involved abortion in only one (5.3%) patient that occurred 5 days after the operation. The mean length of hospital stay was 2.3 ± 0.9 days.
Conclusion
LA for complicated appendicitis in pregnant women was safe for the mother and the fetus regardless of the gestational age. The procedure was associated with a low risk of operative and postoperative surgical complications, which were managed conservatively. Further, the incidence of fetal loss was also low.

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