Abstract
Study Objective To evaluate the surgical, obstetric outcomes between laparoscopic and laparotomy management for adnexal mass during pregnancy. Design Retrospective comparative study. Setting University tertiary care referral center for endoscopic surgery. Patients or Participants Eighty-six pregnant women who underwent 86 operations for suspected adnexal pathology at our institute. Laparoscopy was performed during the first trimester in 13 patients, second trimester in 33 patients. The remaining 40 patients underwent laparotomy, 8 during the first trimester, 31 during the second trimester and 1 during third trimester. Interventions Laparoscopy or laparotomy for the management of adnexal masses during pregnancy from January 1996 to March 2012. Measurements and Main Results Operative and postoperative maternal complications, miscarriage, congenital malformations, and newborn long-term outcome. Results The laparoscopy group had a significantly shorter mean operative time (68.5±4.2 vs 49.9±3.4 min, P=0.0008), lower mean blood loss (19.9±2.3 vs 45.3±4.6 ml), shorter mean flatus time after operation (22.0±0.7 vs 43.1±2.1 h) and mean hospital stay (2.8±0.1 vs 6.6±0.2 days, P=0.004) than the laparotomy group. All group patients didn't require a blood transfusion. In multivariate analysis, there was no significant difference between laparoscopy and laparotomy group in obstetric outcomes, including preterm delivery and miscarriage rate, after adjusting for confounding factors, such as gestational age at surgery, emergency surgery and mass size. The median follow-up time was 3.5 years (range, 1.5-11.5 years). The median age of the child was 2.5 years (range, 1-9.5 years). All babies were healthy. Conclusion In this retrospective study, the successful outcome suggests that operative laparoscopy for adnexal masses performed during pregnancy is safe and feasible when performed by experienced surgeons. Procedures in the second trimester without emergency indications is preferable.
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