Die laparoskopische Appendektomie in der Schwangerschaft

Abstract

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. 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. 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. 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.