TORONTO — Laparoscopic appendectomy in pregnant patients is as safe as open appendectomy and has several advantages, according to a review presented at the annual meeting of the Canadian Association of Thoracic Surgeons. A retrospective study of 40 cases of suspected appendicitis treated laparoscopically at St. François d'Assise Hospital in Quebec City showed that immediate complication rates and preterm labor rates were similar to those after open appendectomies, Dr. Patrice Lemieux said at the meeting.
The review, which Dr. Lemieux called the second-largest series of laparoscopic appendectomies in pregnancy in the literature, also showed that the laparoscopic approach was more versatile in cases where the appendix was displaced by the gravid uterus.
Appendicitis in pregnancy is a diagnostic challenge for the surgeon. CT scanning is not an option, and ultrasound is often suboptimal, said Dr. Lemieux, of Laval University, Quebec City.
He and his colleagues evaluated their institution's 10-year experience with laparoscopic appendectomy in 14 first-trimester, 20 second-trimester, and 6 third-trimester patients. They looked at the immediate preterm delivery rate, which they defined as delivery within 1 month of surgery, short-term complications, and pregnancy outcomes. The women were contacted by telephone if relevant information was missing in their charts.
Three women experienced minor complications—wound infection, cystitis, and ileus—and were treated with medication. Major complications occurred in two women: an intra-abdominal abscess and a uterine perforation. This patient did well and delivered a healthy baby at 36 weeks and 4 days, he added.
There were no cases of immediate preterm labor in the month following surgery. The mean delivery time was 38 weeks. No differences were found between trimesters of pregnancy in preterm labor rates, complication rates, or operative time. The mean operative time was 49 minutes.
There were no fetal mortalities, which contrasted with published rates of 5%–14%. This may have been because of the low perforated appendix rate—9%—in the series, Dr. Lemieux said.