Abstract
Study Objective To compare maternal and fetal outcomes in laparoscopy versus laparotomy in the surgical management of adnexal masses in pregnancy. Design Systematic Review and Meta-Analysis. 8027 titles and abstracts were screened, followed by 691 full articles. Ten retrospective studies were included in the meta-analysis. Setting N/A Patients or Participants N/A Interventions N/A Measurements and Main Results 287 women underwent laparoscopy and 496 underwent laparotomy. The median age undergoing laparoscopy versus laparotomy was similar (27.7 years and 27.3 years, respectively, p=0.80), as was the mean gestational age at time of surgery (16.0 weeks in laparoscopy and 15.6 weeks in laparotomy, p=0.59). The median size of the mass was 7.8 cm in laparoscopy and 9.1 cm in laparotomy (p=0.07). The most common pathology was dermoid (36%) and the overall risk of malignancy was 1%. Women undergoing laparoscopy were less likely to have a preterm delivery (OR 0.72 [0.33, 1.45]). However, laparoscopy was more likely to result in spontaneous abortion (OR 1.67 [0.67, 4.33]). Operative time was increased by 12.6 minutes in laparoscopy as compared to laparotomy (median 76.6 minutes vs 64.0 minutes, p=0.05). The Estimated blood loss (EBL) was lower in laparoscopy by 26.6 mL (median 48.9 mL for laparoscopy versus 75.5 mL for laparotomy, p=0.05). The median length of hospital stay (LOS) was 2.8 days for those undergoing laparoscopy versus 5.8 days for laparotomy (p Conclusion Laparoscopy for the surgical management of adnexal masses is associated with a lower EBL and reduced LOS. There is no statistically significant difference in the odds of preterm delivery or spontaneous abortion in laparoscopy as compared to laparotomy. Additional surgical complications and fetal outcomes of interest were not compared due to heterogeneity of the included articles. Laparoscopy is a safe alternative to laparotomy for the surgical management of adnexal masses in pregnancy.
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