INCIDENCE OF CONVERSION TO OPEN APPENDECTOMY FROM LAPAROSCOPIC APPENDECTOMY IN PREGNANT FEMALES

SSU HASSAN; T MAHAR; B ZAHRA

doi:10.54112/bcsrj.v2024i1.684

Authors

SSU HASSAN Department of Surgery, Nishtar Medical University and Hospital (NMU & H) Multan, Pakistan
T MAHAR Department of Surgery, Nishtar Medical University and Hospital (NMU & H) Multan, Pakistan
B ZAHRA Department of Surgery, Nishtar Medical University and Hospital (NMU & H) Multan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.684

Keywords:

Appendix, Acute appendicitis, Laparoscopic, Pregnancy

Abstract

Acute appendicitis is a common non-obstetric indication for surgery in pregnant women, and the choice between laparoscopic and open appendectomy remains a subject of debate. While the benefits of laparoscopic appendectomy over open surgery are well-established in the non-pregnant population, consensus is lacking in the pregnant cohort. This study aims to contribute insights into the optimal surgical approach for acute appendicitis in pregnant women. The study, conducted from January 2020 to December 2022 at Nishtar Hospital, Multan, focused on 45 pregnant women presenting with abdominal pain and diagnosed with acute appendicitis. Two patients were discharged after magnetic resonance imaging (MRI) revealed a normal appendix. Of the remaining 43 cases, 27 were in the first trimester, 8 in the second trimester, and 8 in the third trimester. All patients underwent successful laparoscopic appendectomy without any conversion to open surgery. The laparoscopic procedure duration ranged from 50 to 80 minutes, with an average postoperative hospital stay of 1.5-3 days. Postoperative wound infection occurred in three patients (6.66%), and two patients (4.44%) experienced preterm labor. Fetal outcomes, assessed through Apgar grading, size, and weight, showed no notable abnormalities after birth. Laparoscopic appendectomy, regardless of gestational age, proves generally safe and suitable for pregnant women with acute appendicitis. The procedure has minimal complications, making it a viable and preferred option during pregnancy. These findings advocate for the continued consideration of laparoscopic appendectomy as a standard approach for managing acute appendicitis in pregnant patients.

Downloads

Download data is not yet available.

References

Alkatary, M. M., and Bahgat, N. A. (2017). Laparoscopic versus open appendectomy during pregnancy. International Surgery Journal 4, 2387-2391.

Bhandari, T. R., Shahi, S., and Acharya, S. (2017). Acute appendicitis in pregnancy and the developing world. International Scholarly Research Notices 2017.

Corneille, M. G., Gallup, T. M., Bening, T., Wolf, S. E., Brougher, C., Myers, J. G., Dent, D. L., Medrano, G., Xenakis, E., and Stewart, R. M. (2010). The use of laparoscopic surgery in pregnancy: evaluation of safety and efficacy. The American journal of surgery 200, 363-367.

Cox, T., Huntington, C., Blair, L., Prasad, T., Lincourt, A., Augenstein, V., and Heniford, B. (2016). Laparoscopic appendectomy and cholecystectomy versus open: a study in 1999 pregnant patients. Surgical Endoscopy 30, 593-602.

Eom, J. M., Hong, J. H., Jeon, S. W., Choi, J. S., Lee, J. H., Kim, H. O., Kim, H., Choi, P. C., and Han, S. K. (2012). Safety and clinical efficacy of laparoscopic appendectomy for pregnant women with acute appendicitis. Annals of the Academy of Medicine-Singapore 41, 82.

Garcia, E. M., Camacho, M. A., Karolyi, D. R., Kim, D. H., Cash, B. D., Chang, K. J., Feig, B. W., Fowler, K. J., Kambadakone, A. R., and Lambert, D. L. (2018). ACR Appropriateness Criteria® right lower quadrant pain-suspected appendicitis. Journal of the American College of Radiology 15, S373-S387.

Günaydin, B. (2012). Anesthetic management for non-obstetric surgery during pregnancy. Turkish Journal of Anaesthesiology & Reanimation 40, 1.

Ietto, G., Amico, F., Pettinato, G., Iori, V., and Carcano, G. (2021). Laparoscopy in emergency: why not? Advantages of laparoscopy in a significant emergency: a review. Life 11, 917.

Lee, S. H., Lee, J. Y., Choi, Y. Y., and Lee, J. G. (2019). Laparoscopic appendectomy versus open appendectomy for suspected appendicitis during pregnancy: a systematic review and updated meta-analysis. BMC surgery 19, 1-12.

Lemieux, P., Rheaume, P., Levesque, I., Bujold, E., and Brochu, G. (2009). Laparoscopic appendectomy in pregnant patients: a review of 45 cases. Surgical endoscopy 23, 1701-1705.

MAZZE, R., and KÄLLÉN, B. (1992). Appendectomy During Pregnancy: A Swedish Registry Study of 778 Cases. Survey of Anesthesiology 36, 69-70.

McGory, M. L., Zingmond, D. S., Tillou, A., Hiatt, J. R., Ko, C. Y., and Cryer, H. M. (2007). Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. Journal of the American College of Surgeons 205, 534-540.

Ml, M. (2007). Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 205, 534-540.

Obsa, M. S., Adema, B. G., Shanka, G. M., Lake, E. A., Azeze, G. A., and Fite, R. O. (2020). Prevalence of acute appendicitis among patient admitted for acute abdomen in Ethiopia: systematic review and meta-analysis. International Journal of Surgery Open 26, 154-160.

Pearl, J., Price, R., Richardson, W., and Fanelli, R. (2011). Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surgical endoscopy 25, 3479-3492.

Samardzic, J., Delibegovic, S., Latic, F., Latic, A., and Kraljik, D. (2011). Laparoscopic appendectomy is safe procedure in the pregnant patients in second trimester. Med Arh 65, 125-126.

Sathish Prabhu, P. (2016). A comparative study of laparoscopic appendectomy Versus open appendectomy in terms of postoperative pain, post operative complications, duration of the hospital stay, return to the work, cosmetic benefit, duration of time of the surgery in our institution, Chengalpattu Medical College, Chengalpattu.

Schwartz, S. (1999). shires GT, Spencer FC, Daly JM. Principles of surgery. 7th ed. USA, MC Grow-Hill Co, 53-76.

ŞENOCAK, R., ÇELİK, S. U., and KAYMAK, Ş. (2020). Diagnosis, management and clinicopathological features of acute appendicitis in pregnant women and its impact on fetal outcomes. İstanbul Tıp Fakültesi Dergisi, 135-140.

Talha, A., El-Haddad, H., Ghazal, A.-E., and Shehata, G. (2020). Laparoscopic versus open appendectomy for perforated appendicitis in adults: randomized clinical trial. Surgical endoscopy 34, 907-914.

Thomson, J.-E., Kruger, D., Jann-Kruger, C., Kiss, A., Omoshoro-Jones, J., Luvhengo, T., and Brand, M. (2015). Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety. Surgical endoscopy 29, 2027-2032.

Ueberrueck, T., Koch, A., Meyer, L., Hinkel, M., and Gastinger, I. (2004). Ninety-four appendectomies for suspected acute appendicitis during pregnancy. World journal of surgery 28, 508-511.

Vigneswaran, S. (2020). A Study on Laparoscopic Versus Open Appendicectomy: A Comparative study, Thanjavur Medical College, Thanjavur.

Walsh, C. A., Tang, T., and Walsh, S. R. (2008). Laparoscopic versus open appendicectomy in pregnancy: a systematic review. International Journal of Surgery 6, 339-344.