Laparoscopic appendectomy during pregnancy: hemostasiological aspects

Abstract

Aim. To study and evaluate changes in blood coagulation system in laparoscopic treatment of acute appendicitis in different pregnancy terms.Methods. In a conducted study сhanges in blood coagulation system were evaluated in 75 pregnant women in different gestation periods who underwent laparoscopic appendectomy. Gestational age was from 4-5 to 35-36 weeks. Interventions were performed with the use of endovideosurgical complex «Olympus» OTV-SC. The pressure of carbon dioxide in the abdominal cavity was within 10-12 mm Hg. The indicators of blood coagulation system were evaluated with the use of automatic coagulometer «Amelung Coagulometr KC 4A» (Trinity Biotech, Ireland). For the diagnosis of intravascular coagulation D-dimer level in blood plasma was evaluated with immunoturbodimetric assay with latex-test «Tina-quant а D-Dimer» («Roche Diagnostics», USA) in the system «Roche/Hitachi Сobas c 6000». Fibrinolytic activity was evaluated with the use of M.A. Kotovschikova and B.I. Kuznik’s method.Results. It was found that changes in hemostasis system during laparoscopic treatment of acute appendicitis in pregnant women indicate significant increase of blood coagulation potential, both before and after laparoscopic appendectomy. This state of blood clotting system can be regarded as adequate adaptive response to aggression, designed to reduce probable or actual bleeding.Conclusion. Hemostasiologic indices during laparoscopic treatment of acute appendicitis in pregnancy are characterized by a significant intensification of the blood coagulation potential, however activation of the regulatory mechanisms of blood coagulation during endovideosurgical intervention is within the physiological norms; these changes are minimal, and laparoscopic appendectomy is the method of choice for pregnant women in different periods of gestation.