Laparoscopic versus open appendicectomy in pregnancy: experience from a single institution and meta-analysis.

Abstract

Acute appendicitis remains an uncommon cause of non-obstetric abdominal pain during pregnancy, with surgery being the preferred management option. We examined our experience with the surgical management of appendicitis during pregnancy, particularly the risk of foetal loss during the 1st and 2nd trimester and performed a meta-analysis of the available literature. We performed a retrospective analysis of all patients who had an appendicectomy during pregnancy (January 2010 to December 2019) and a meta-analysis comparing foetal death in open appendicectomy versus laparoscopic appendicectomy during the 1st and 2nd trimester. Seventy pregnant patients were included in our study (57 laparoscopic, 13 open). There were 4 foetal deaths during the study period (7%), all of which occurred after the laparoscopic approach (P-value=0.578). Open appendicectomies were associated with an increased risk of pre-term delivery (P-value=0.038). The meta-analysis of 9 studies, which included 311 patients, showed that there was no significant difference between OA and LA in foetal deaths during the 1st and 2nd trimesters (1st trimester foetal deaths: 9/143 laparoscopic versus 4/57 open, M-H risk difference-0.02, 95% CI, -0.14 to 0.10): 2nd trimester foetal deaths: 7/159 laparoscopic versus 2/154 Open, M-H risk difference 0.03, 95% CI, -0.02 to 0.09). Our findings suggest there is no increased risk of foetal loss in pregnant patients undergoing a laparoscopic appendicectomy.