Laparotomy versus laparoscopy for antenatal appendectomy

Abstract

YAIR BLUMENFELD, MEREDITH ROCHON, KEITH EDDLEMAN, JEFFREY FREED, Mount Sinai School of Medicine, Obstetrics, Gynecology and Reproductive Science, New York, New York, Mount Sinai School of Medicine, Surgery, New York, New York OBJECTIVE: To compare intra-operative and post-operative differences between laparotomy and laparoscopy for antenatal appendectomy, and to determine differences in obstetrical outcomes between patients whose final pathology showed acute appendicitis to those with normal appendices. STUDY DESIGN: Retrospective cohort study of all antenatal appendectomies performed at a single institution from 1/1993 to 12/2004. Medical records were reviewed to ascertain maternal demographics, procedure details, and pregnancy outcomes. RESULTS: Sixty patients had appendectomies during the study period, 32 (53%) by laparoscopy (Lsc) and 28 by laparotomy (X-lap). Baseline demographics were similar between the two groups. Lsc was performed more frequently in the second half of the study period (44% v. 76%, p=.024). Those undergoing Lsc had their procedures performed at a significantly earlier gestational age (16.8 range 3-30 wks vs. 22.2 range 9-36 wks, p=.005), had longer procedures (61G25 min v 49G16 min, p=.024) and had a significantly shorter median hospital stay (2 range 1-36 days v 3 range 1-15 days, p=.004). Two patients required reoperation and transfusion for bleedingboth in the Lsc group (procedures at 20 and 30 wks). There was no difference in pregnancy outcome between the groups, though there was a trend toward higher rates of PTL in the X-lap group (48% v 10%, p=.07). Overall, 29% of patients had PTL, 18% PTD, 12% PPROM, and 23% of babies were admitted to the NICU. Despite this, mean GA at delivery was 38.5 wks with a mean birthweight of 3101G648g. Twenty-five percent of patients undergoing surgery had a normal appendix. There was no difference in outcome between those with appendicitis and those with a normal appendix. CONCLUSION: Shorter hospital stay and a trend towards a decreased rate of preterm labor suggest that laparoscopy should be the preferred approach for antenatal appendectomy whenever technically feasible. Increased experience with laparascopy in the future may further improve pregnancy outcome.