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Kumar SS, Collings AT, Wunker C, Athanasiadis DI, DeLong CG, Hong JS, Ansari MT, Abou-Setta A, Oliver E, Berghella V, Alli V, Hassan I, Hollands C, Sylla P, Slater BJ, Palazzo F. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 2024; 38:2947-2963. [PMID: 38700549 PMCID: PMC11133165 DOI: 10.1007/s00464-024-10810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/21/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND When pregnant patients present with nonobstetric pathology, the physicians caring for them may be uncertain about the optimal management strategy. The aim of this guideline is to develop evidence-based recommendations for pregnant patients presenting with common surgical pathologies including appendicitis, biliary disease, and inflammatory bowel disease (IBD). METHODS The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines Committee convened a working group to address these issues. The group generated five key questions and completed a systematic review and meta-analysis of the literature. An expert panel then met to form evidence-based recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Expert opinion was utilized when the available evidence was deemed insufficient. RESULTS The expert panel agreed on ten recommendations addressing the management of appendicitis, biliary disease, and IBD during pregnancy. CONCLUSIONS Conditional recommendations were made in favor of appendectomy over nonoperative treatment of appendicitis, laparoscopic appendectomy over open appendectomy, and laparoscopic cholecystectomy over nonoperative treatment of biliary disease and acute cholecystitis specifically. Based on expert opinion, the panel also suggested either operative or nonoperative treatment of biliary diseases other than acute cholecystitis in the third trimester, endoscopic retrograde cholangiopancreatography rather than common bile duct exploration for symptomatic choledocholithiasis, applying the same criteria for emergent surgical intervention in pregnant and non-pregnant IBD patients, utilizing an open rather than minimally invasive approach for pregnant patients requiring emergent surgical treatment of IBD, and managing pregnant patients with active IBD flares in a multidisciplinary fashion at centers with IBD expertise.
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Affiliation(s)
- Sunjay S Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Amelia T Collings
- Hiram C. Polk, Jr Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Claire Wunker
- Department of Surgery, Saint Louis University, Saint Louis, MO, USA
| | | | - Colin G DeLong
- Department of Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Julie S Hong
- Department of Surgery, NewYork-Presbyterian Queens, New York, NY, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ahmed Abou-Setta
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Emily Oliver
- Department of Obstetrics, Gynecology and Reproductive Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Vincenzo Berghella
- Department of Obstetrics & Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vamsi Alli
- Department of Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Imran Hassan
- Department of Surgery, Mercy Medical Center Cedar Rapids, Cedar Rapids, IA, USA
| | - Celeste Hollands
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Patricia Sylla
- Division of Colon and Rectal Surgery, Mount Sinai Health System, New York, NY, USA
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
- Thomas Jefferson University, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA.
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2
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Haataja A, Kokki H, Uimari O, Kokki M. Non-obstetric surgery during pregnancy and the effects on maternal and fetal outcomes: A systematic review. Scand J Surg 2023; 112:187-205. [PMID: 37329286 DOI: 10.1177/14574969231175569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Non-obstetric surgery is fairly common in pregnant women. We performed a systematic review to update data on non-obstetric surgery in pregnant women. The aim of this review was to evaluate the effects of non-obstetric surgery during pregnancy on pregnancy, fetal and maternal outcomes. METHODS A systematic literature search of MEDLINE and Scopus was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search span was from January 2000 to November 2022. Thirty-six studies matched the inclusion criteria, and 24 publications were identified through reference mining; 60 studies were included in this review. Outcome measures were miscarriage, stillbirth, preterm birth, low birth weight, low Apgar score, and infant and maternal morbidity and mortality rates. RESULTS We obtained data for 80,205 women who underwent non-obstetric surgery and data for 16,655,486 women who did not undergo surgery during pregnancy. Prevalence of non-obstetric surgery was between 0.23% and 0.74% (median 0.37%). Appendectomy was the most common procedure with median prevalence of 0.10%. Near half (43%) of the procedures were performed during the second trimester, 32% during the first trimester, and 25% during the third trimester. Half of surgeries were scheduled, and half were emergent. Laparoscopic and open techniques were used equally for abdominal cavity. Women who underwent non-obstetric surgery during pregnancy had increased rate of stillbirth (odds ratio (OR) 2.0) and preterm birth (OR 2.1) compared to women without surgery. Surgery during pregnancy did not increase rate of miscarriage (OR 1.1), low 5 min Apgar scores (OR 1.1), the fetus being small for gestational age (OR 1.1) or congenital anomalies (OR 1.0). CONCLUSIONS The prevalence of non-obstetric surgery has decreased during last decades, but still two out of 1000 pregnant women have scheduled surgery during pregnancy. Surgery during pregnancy increases the risk of stillbirth, and preterm birth. For abdominal cavity surgery, both laparoscopic and open approaches are feasible.
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Affiliation(s)
- Anna Haataja
- PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Hannu Kokki
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Outi Uimari
- PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Merja Kokki
- Department of Anaesthesia and Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
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3
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Cusimano MC, Liu J, Azizi P, Zipursky J, Sajewycz K, Sussman J, Kishibe T, Wong E, Ferguson SE, D'Souza R, Baxter NN. Adverse Fetal Outcomes and Maternal Mortality Following Nonobstetric Abdominopelvic Surgery in Pregnancy: A Systematic Review and Meta-analysis. Ann Surg 2023; 278:e147-e157. [PMID: 34966066 DOI: 10.1097/sla.0000000000005362] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify the absolute risks of adverse fetal outcomes and maternal mortality following nonobstetric abdominopelvic surgery in pregnancy. SUMMARY BACKGROUND DATA Surgery is often necessary in pregnancy, but absolute measures of risk required to guide perioperative management are lacking. METHODS We systematically searched MEDLINE, EMBASE, and EvidenceBased Medicine Reviews from January 1, 2000, to December 9, 2020, for observational studies and randomized trials of pregnant patients undergoing nonobstetric abdominopelvic surgery. We determined the pooled proportions of fetal loss, preterm birth, and maternal mortality using a generalized linear random/mixed effects model with a logit link. RESULTS We identified 114 observational studies (52 [46%] appendectomy, 34 [30%] adnexal, 8 [7%] cholecystectomy, 20 [17%] mixed types) reporting on 67,111 pregnant patients. Overall pooled proportions of fetal loss, preterm birth, and maternal mortality were 2.8% (95% CI 2.2-3.6), 9.7% (95% CI 8.3-11.4), and 0.04% (95% CI 0.02-0.09; 4/10,000), respectively. Rates of fetal loss and preterm birth were higher for pelvic inflammatory conditions (eg, appendectomy, adnexal torsion) than for abdominal or nonurgent conditions (eg, cholecystectomy, adnexal mass). Surgery in the second and third trimesters was associated with lower rates of fetal loss (0.1%) and higher rates of preterm birth (13.5%) than surgery in the first and second trimesters (fetal loss 2.9%, preterm birth 5.6%). CONCLUSIONS Absolute risks of adverse fetal outcomes after nonobstetric abdom- inopelvic surgery vary with gestational age, indication, and acuity. Pooled estimates derived here identify high-risk clinical scenarios, and can inform implementation of mitigation strategies and improve preoperative counselling.
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Affiliation(s)
- Maria C Cusimano
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Jessica Liu
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
| | - Paymon Azizi
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
| | - Jonathan Zipursky
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katrina Sajewycz
- School of Medicine, Faculty ofHealth Sciences, Queen's University, Kingston, ON, Canada
| | - Jess Sussman
- School of Medicine, Faculty ofMedicine, University of Toronto, Toronto, ON, Canada
| | - Teruko Kishibe
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Health Sciences Library, St. Michael's Hospital, Toronto, ON, Canada
| | - Eric Wong
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah E Ferguson
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/Sinai Health Systems, Toronto, ON, Canada
| | - Rohan D'Souza
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Division of Maternal Fetal Medicine, Mount Sinai Hospital/Sinai Health Systems, Toronto, ON, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne ViC, Australia
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4
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Michos G, Dagklis T, Papanikolaou E, Peitsidis NI, Kalogiannidis IA, Mamopoulos AM, Athanasiadis A. Laparoscopy in Pregnancy: A Comparative Review of National Guidelines. Cureus 2023; 15:e38904. [PMID: 37303332 PMCID: PMC10257531 DOI: 10.7759/cureus.38904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Gynecological and general surgical conditions requiring surgical management during pregnancy constitute a medical challenge, which often entails the collaboration of numerous medical specialties. In recent years, laparoscopy in pregnancy has been accepted as a safe alternative to open surgery. This has led gynecological societies to conduct studies and issue guidelines related to laparoscopy in pregnancy, with a view to assisting and guiding clinicians and surgeons. The aim of this study was to review and compare the recommendations from various published national guidelines on laparoscopy in pregnant women. To that end, a descriptive review of guidelines from the British Society for Gynaecological Endoscopy (BSGE), the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the Society of Obstetricians and Gynaecologists of Canada (SOCG), and the Collège National des Gynécologues et Obstétriciens Français (CNGOF) was conducted. Regarding diagnosis, the SAGES and SOCG societies recommend ultrasound as the preferred and safe imaging technique during pregnancy. In terms of the optimal timing for laparoscopic intervention, BSGE and SAGES do not restrict the laparoscopic approach based on safety, depending on the gestation week, whereas SOCG and CNGOF propose early second trimester and first and second quarter of pregnancy respectively. There is an overall consensus regarding patient positioning, initial port placement, insufflation pressure during the operation, venous thromboembolic (VTE) prophylaxis, fetal heart monitoring, and tocolysis among the reviewed guidelines. Moreover, only the BSGE mentions the need for corticosteroids, magnesium sulfate, and anti-D prophylactic administration.
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Affiliation(s)
- Georgios Michos
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Evangelos Papanikolaou
- Private IVF Unit, Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, GRC
| | - Nikolaos I Peitsidis
- Private IVF Unit, Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, GRC
| | - Ioannis A Kalogiannidis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Apostolos M Mamopoulos
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
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5
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Ukhanov AP, Zakharov DV, Zhilin SA, Bolshakov SV, Muminov KD, Aselderov YA. [Laparoscopic appendectomy for acute appendicitis in pregnancy]. Khirurgiia (Mosk) 2023:86-94. [PMID: 37707337 DOI: 10.17116/hirurgia202309186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
The review is devoted to the role of laparoscopic appendectomy in surgical management of acute appendicitis in pregnancy. We analyzed reviews, prospective and retrospective studies in the PubMed, Google, the Springer Link online library, the Cochrane Systematic Review databases. The results of laparoscopic and traditional treatment of acute appendicitis in pregnant women were assessed. We analyzed clinical, epidemiological features in these patients, differential diagnosis of acute appendicitis in pregnant women, indications and contraindications for endoscopic treatment, features of laparoscopic procedures. Comparative assessment of laparoscopic and open surgeries for acute appendicitis in pregnant women was carried out. We also estimated the influence of surgical treatment of acute appendicitis on subsequent course of pregnancy.
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Affiliation(s)
- A P Ukhanov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
- Jaroslav the Wise Institute of Medical Education of Novgorod State University, Veliky Novgorod, Russia
| | - D V Zakharov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
- Jaroslav the Wise Institute of Medical Education of Novgorod State University, Veliky Novgorod, Russia
| | - S A Zhilin
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
- Jaroslav the Wise Institute of Medical Education of Novgorod State University, Veliky Novgorod, Russia
| | - S V Bolshakov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
| | - K D Muminov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
| | - Yu A Aselderov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
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6
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Paratubal Cystectomy in a Pregnant Woman Using the Single-Incision Laparoscopic Surgery (SILS) Technique. Case Rep Obstet Gynecol 2022; 2022:2802767. [PMID: 35875340 PMCID: PMC9303160 DOI: 10.1155/2022/2802767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction The proliferation of prenatal ultrasound has enhanced the detection of adnexal masses during pregnancy. The presentation necessitates a clear approach to investigation and treatment that balances both maternal and fetal risk. Laparoscopy is a safe approach to surgical management in the pregnant patient, and SILS may contribute to minimising perioperative complications. Case Presentation. We present the case of a 21-year-old female in her second trimester of pregnancy presenting with a large 20 cm right adnexal cyst. We proceeded with laparoscopic cystectomy via the SILS technique. There were no intraoperative complications, and she recovered well postoperatively. Conclusion Laparoscopic resection of adnexal lesions is safe during pregnancy and should be favoured over the open approach. SILS minimises incision sites and has potential for reduction in perioperative morbidity.
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7
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Liew AN, Lim KYY, Quach D, Tsui LW, Croagh D, Ackermann TG. Laparoscopic versus open appendicectomy in pregnancy: experience from a single institution and meta-analysis. ANZ J Surg 2022; 92:1071-1078. [PMID: 35373462 DOI: 10.1111/ans.17672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/24/2022] [Accepted: 03/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION Our findings suggest there is no increased risk of foetal loss in pregnant patients undergoing a laparoscopic appendicectomy.
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Affiliation(s)
- Amos Nepacina Liew
- Department of General Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Kylie Yen-Yi Lim
- Department of General Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Diane Quach
- Department of Obstetrics and Gynaecology, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Lap Wah Tsui
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Daniel Croagh
- Department of Upper Gastrointestinal/Hepatobiliary and General Surgery Unit, Monash Health, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Travis George Ackermann
- Department of General Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia.,Department of Upper Gastrointestinal/Hepatobiliary and General Surgery Unit, Monash Health, Melbourne, Victoria, Australia
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8
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Rountis A, Dimitroulis D, Nikiteas N. Laparoscopic appendectomy vs open appendectomy during pregnancy: a systematic re-view. Hippokratia 2022; 26:1-6. [PMID: 37124278 PMCID: PMC10132395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Acute appendicitis and cholecystitis during pregnancy are the most common non-obstetrical surgical emergencies and can create severe clinical issues. Surgical treatment tends to be the method physicians recommend due to its tolerability and safety. During pregnancy, surgical intervention should minimize fetal risk without compromising the mother's health, although a favorable outcome for pregnant women is heavily dependent on accurate, early diagnosis and prompt intervention. Furthermore, the physicians should remain informed on the differences in current techniques to optimize the outcome of the operation. METHODS This article performs a systematic review of the literature to examine whether laparoscopic treatment of acute appendicitis in pregnancy is a better option when compared to open surgery. We searched all major medical databases, identified the most relevant published studies on the subject, and performed a statistical analysis to answer that question. RESULTS We identified 15 studies for inclusion, and their data were extracted. The resulting pool referred to 2,837 pregnant patients. Of those included patients, 1,103 underwent laparoscopic surgery and 1,656 had open surgery. All surgeries occurred in the second trimester. For laparoscopic surgery, the fetal demises rate was 2.44 % (27 deaths), and the preterm deliveries rate was 9.79 % (108 deliveries) as opposed to open surgery with a fetal demise rate of 2.64 % (48 deaths), and preterm deliveries rate at 10.7 % (178 deliveries). CONCLUSIONS Our meta-analysis and data suggest that laparoscopic appendectomy is a safer option for treatment. There is a reduced risk of fetal demise and preterm delivery for pregnant women. HIPPOKRATIA 2022, 26 (1):1-6.
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Affiliation(s)
- A Rountis
- 1st Department of Obstetrics and Gynecology, "Alexandra" General Hospital, Athens, Greece
- 3rd Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, National and Kapodistrian University, Athens, Greece
| | - D Dimitroulis
- 3rd Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, National and Kapodistrian University, Athens, Greece
- 2nd Department of Propaedeutic Surgery, «Laiko» General Hospital, Athens, Greece
| | - N Nikiteas
- 3rd Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, National and Kapodistrian University, Athens, Greece
- 2nd Department of Propaedeutic Surgery, «Laiko» General Hospital, Athens, Greece
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9
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Zhang J, Wang M, Xin Z, Li P, Feng Q. Updated Evaluation of Laparoscopic vs. Open Appendicectomy During Pregnancy: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:720351. [PMID: 34631781 PMCID: PMC8495069 DOI: 10.3389/fsurg.2021.720351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/16/2021] [Indexed: 02/05/2023] Open
Abstract
To explore the updated evaluation about the obstetrical and perioperative outcomes of laparoscopic appendicectomy (LA) for pregnancy appendicitis compared with open appendicectomy (OA). Two reviewers independently searched the PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, and Web of Science databases to screen eligible studies up to December 2020. Only clinical researches, no < 10 cases for LA and OA group were included. Twenty retrospective studies with 7,248 pregnant women, evaluating LA and OA in surgical and obstetrical outcomes, were included. The weighted mean difference (WMD) with 95% CI and odds ratio (OR) was used to compare continuous and dichotomous variables. It seems LA was connected with significantly shorter hospital time and lower wound infection [mean difference (MD), −0.57 days; 95% CI, −0.96 to −0.18; p = 0.004 and OR, 0.34; 95% CI, 0.18 to 0.62; p = 0.0005, respectively]. The incidence of fetal loss after LA was higher than OA (OR,1.93; 95% CI, 1.39–2.69; p < 0.0001). It was almost similar in the rate of preterm delivery (OR, 0.80; 95% CI, 0.48 to 1.34; p = 0.40) and other perioperative and obstetrical complications (p > 0.05). Our results indicated that the occurrence of fetal loss after LA should not be ignored. Caution, skillful operation, and thoroughly informed consent about the advantages and disadvantages of laparoscopy are necessary. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier: CRD42021233150.
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Affiliation(s)
- Jia Zhang
- Department of Breast Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Miye Wang
- Engineering Research Center of Medical Information Technology, Ministry of Education, West China Hospital, Sichuan University, Chengdu, China.,Information Technology Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zechang Xin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepatobiliary and Pancreatic Surgery Unit I, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ping Li
- Northern Jiangsu People's Hospital, Clinic Medical College, Yangzhou University, Yangzhou, China
| | - Qingbo Feng
- Department of Liver Surgery and Liver Transplantation Centre, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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10
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Laparoscopic appendectomy with left lateral tilt in pregnant women in the second and third trimesters: A clinical case series in a single Vietnam centre. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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11
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Angeramo CA, Peña ME, Maqueda Vocos M, Schlottmann F. Surgical and obstetrical outcomes after laparoscopic appendectomy during pregnancy: a case-matched analysis. Arch Gynecol Obstet 2021; 304:1535-1540. [PMID: 34432110 DOI: 10.1007/s00404-021-06201-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Laparoscopic appendectomy (LA) for acute appendicitis (AA) remains controversial during pregnancy. We aimed to determine surgical and obstetrical outcomes of LA in pregnant women. METHODS Pregnant women who underwent LA for AA (G1) between 2006 and 2019 were included and matched by gender, age, white blood cells, ASA score, and presence of peritonitis in a 1:2 ratio with non-pregnant women who had undergone LA (G2). Demographics and surgical outcomes were compared between groups. Preterm delivery and fetal loss rate were also analyzed. RESULTS From a total of 2009 LA, 18 (0.9%) were included in G1 and 36 (1.8%) in G2. There were no intraoperative complications or converted surgeries. Length of hospital stay was longer in G1 (G1: 2.6 vs G2: 1.4 days, p < 0.01). There was no difference in overall morbidity and readmission rates. Fetal loss and preterm delivery rates were both 11%. CONCLUSION LA in pregnant women has similar intraoperative and postoperative outcomes as those achieved in non-pregnant patients. In addition, the laparoscopic approach does not seem to jeopardize obstetrical outcomes.
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Affiliation(s)
- Cristian A Angeramo
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina.
| | - María E Peña
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina
| | - Martín Maqueda Vocos
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina
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12
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Laparoscopic treatment for appendicitis during pregnancy: Retrospective cohort study. Ann Med Surg (Lond) 2021; 68:102668. [PMID: 34408866 PMCID: PMC8361228 DOI: 10.1016/j.amsu.2021.102668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background Acute appendicitis is the most frequent non-obstetric surgical emergency during pregnancy. The benefits of laparoscopy during pregnancy are well known, but complications can occur, and these can affect both the mother and/or the foetus.We present results of laparoscopic surgical treatment of acute appendicitis in pregnant women, analysing the occurrence of adverse postoperative, obstetric and foetal outcomes and reviewing literature. Materials and methods Retrospective observational study on pregnant women with a preoperative diagnosis of acute appendicitis. Results n = 63, mean age 28.4 years, average gestational age of 17.7 weeks (3-30 weeks). 6.4 % exploratory laparoscopies, 92 % laparoscopic appendectomies and one right colectomy were performed. Conversion rate was 3.2 %. When symptoms begun within 48 hours prior to surgery, a perforated appendicitis was found in 11 %; whereas when the time from symptom onset to surgery was greater than or equal to 48 hours, it was evident in 31 % of the cases (p 0.008). The only independent variable associated with the presence of postoperative complications was symptom duration prior to surgery greater than or equal to 48 hours (OR 4.8; 95 % CI 1.1-16.2; p 0.04). Seven minor and 2 mayor postoperative complications were observed. Patients with complications spent, on average, twice as many days hospitalized (p < 0.001); and had 8 times more risk of preterm delivery (p 0.03). Obstetric complications were more frequent in pregnant women operated during the first trimester. Foetal mortality was 1.6 %. Conclusion Surgical morbidity of acute appendicitis in pregnant women is linked to the delay in the diagnosis and treatment of the inflammatory condition. Laparoscopic appendectomy during pregnancy is not exempt from postoperative, obstetric and foetal complications. It is necessary to standardize the definitions of "complication" in order to collate reliably the outcomes presented in the literature.
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Safety of appendectomy during pregnancy in the totally laparoscopic age. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:68-75. [PMID: 35600787 PMCID: PMC8965996 DOI: 10.7602/jmis.2021.24.2.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/29/2022]
Abstract
Purpose Acute appendicitis is the most common nonobstetric indication for surgical intervention during pregnancy. In the argument of the optimal surgical approach to acute appendicitis in pregnancy, laparoscopy seems to be won with a similar complication rate and shorter postoperative recovery than open. We aimed to compare perioperative outcomes of appendectomy in pregnant and nonpregnant women in the totally laparoscopic age. Methods We retrospectively analyzed 556 nonincidental appendectomies performed in women (aged 18–45 years) between January 2014 and December 2018. To reduce the confounding effects, we used propensity score considering the variables age, American Society of Anesthesiologists physical status classification, and the operative finding; whether the appendicitis was simple or complicated. After propensity score matching, the outcomes of 15 pregnant women were compared with those of the 30 nonpregnant women. Results All the operations were performed with laparoscopy. Most of the pregnant cases were in their first and second trimester. The postoperative morbidity rate was significantly higher in the pregnant group before propensity score matching; however, the significance disappeared after matching. Operative outcomes and the parameters related to the postoperative recovery were not different between the two groups. Two patients in their first trimester decided to terminate the pregnancy after appendectomy. One patient in her second trimester experienced preterm labor which was resolved spontaneously. There was no other obstetric adverse outcome. Conclusion In the laparoscopy age, appendectomy during pregnancy is safe and not associated with a significantly increased risk of postoperative complication.
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Zeng Q, Aierken A, Gu SS, Yao G, Apaer S, Anweier N, Wu J, Zhao JM, Li T, Tuxun T. Laparoscopic Versus Open Appendectomy for Appendicitis in Pregnancy: Systematic Review and Meta-Analysis. Surg Laparosc Endosc Percutan Tech 2021; 31:637-644. [PMID: 33935257 DOI: 10.1097/sle.0000000000000943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The clinical safety, efficacy and feasibility of laparoscopic appendectomy (LA) compared with open appendectomy (OA) in pregnancy are still controversial. Herein, we are aiming to compare the clinical outcomes of LA and OA in patients with acute appendicitis during their pregnancy. MATERIALS AND METHODS This was a systematic review and meta-analysis of studies comparing laparoscopic and OA in pregnancy identifying using PubMed, Web of science, Embase, The Cochrane Library, Ovid and Scopus. Two independent reviewers extracted data on surgical complication, fetal loss, preterm delivery, hospital stay, Apgar score in both groups. RESULTS Twenty-seven studies with total of 6497 patients (4464 in open and 2031 in laparoscopic group) were included. LA was associated with lower rate of wound infection [odds risk (OR)=3.13, 95% confidence interval (CI): 1.77-5.56, P<0.0001] overall complications (OR=2.15, 95% CI: 1.47-3.14, P<0.0001) and shorter hospitalization (mean difference=0.72, 95% CI: 0.43-1.02, P<0.00001) compared with open group. LA was in a lower risk for 5-minute Apgar score (mean difference=0.09, 95% CI: 0.02-0.17, P=0.01) group than open group. No difference was found regarding preterm delivery between 2 groups. LA was associated with higher fetal loss (OR=0.57, 95% CI: 0.41-0.79, P=0.0007) compared with open surgery. However, laparoscopy was not associated with increased fetal loss after 2010 (OR=0.74, 95% CI: 0.44-1.24, P=0.26) compared with open group. CONCLUSIONS LA in pregnancy seems to be feasible with acceptable outcome, especially in patients with early and mid-trimester period, with sophisticated hands and experienced centers.
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Affiliation(s)
- Qi Zeng
- Department of Liver & Laparoscopic Surgery, Center of Digestive & Vascular Surgey
| | - Amina Aierken
- Center of Health Management, 1st Affiliated Hospital of Xinjiang Medical University, Xinshi District, Urumqi, China
| | - Shen-Sen Gu
- Department of Liver & Laparoscopic Surgery, Center of Digestive & Vascular Surgey
| | - Gang Yao
- Department of Liver & Laparoscopic Surgery, Center of Digestive & Vascular Surgey
| | - Shadike Apaer
- Department of Liver & Laparoscopic Surgery, Center of Digestive & Vascular Surgey
| | | | - Jing Wu
- Department of Liver & Laparoscopic Surgery, Center of Digestive & Vascular Surgey
| | - Jin-Ming Zhao
- Department of Liver & Laparoscopic Surgery, Center of Digestive & Vascular Surgey
| | - Tao Li
- Department of Liver & Laparoscopic Surgery, Center of Digestive & Vascular Surgey
| | - Tuerhongjiang Tuxun
- Department of Liver & Laparoscopic Surgery, Center of Digestive & Vascular Surgey
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Bleeser T, Van Der Veeken L, Devroe S, Vergote S, Emam D, van der Merwe J, Ghijsens E, Joyeux L, Basurto D, Van de Velde M, Deprest J, Rex S. Effects of Maternal Abdominal Surgery on Fetal Brain Development in the Rabbit Model. Fetal Diagn Ther 2021; 48:189-200. [PMID: 33631746 PMCID: PMC7613467 DOI: 10.1159/000512489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Anesthesia during pregnancy can impair fetal neurodevelopment, but effects of surgery remain unknown. The aim is to investigate effects of abdominal surgery on fetal brain development. Hypothesis is that surgery impairs outcome. METHODS Pregnant rabbits were randomized at 28 days of gestation to 2 h of general anesthesia (sevoflurane group, n = 6) or to anesthesia plus laparoscopic appendectomy (surgery group, n = 13). On postnatal day 1, neurobehavior of pups was assessed and brains harvested. Primary outcome was neuron density in the frontal cortex, and secondary outcomes included neurobehavioral assessment and other histological parameters. RESULTS Fetal survival was lower in the surgery group: 54 versus 100% litters alive at birth (p = 0.0442). In alive litters, pup survival until harvesting was 50 versus 69% (p = 0.0352). No differences were observed for primary outcome (p = 0.5114) for surviving pups. Neuron densities were significantly lower in the surgery group in the caudate nucleus (p = 0.0180), but not different in other regions. No differences were observed for secondary outcomes. Conclusions did not change after adjustment for mortality. CONCLUSION Abdominal surgery in pregnant rabbits at a gestational age corresponding to the end of human second trimester results in limited neurohistological changes but not in neurobehavioral impairments. High intrauterine mortality limits translation to clinical scenario, where fetal mortality is close to zero.
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Affiliation(s)
- Tom Bleeser
- Department of Anesthesiology, UZ Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, My FetUZ Fetal Research Center, KU Leuven, Leuven, Belgium
| | - Lennart Van Der Veeken
- Department of Development and Regeneration, My FetUZ Fetal Research Center, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium
| | - Sarah Devroe
- Department of Anesthesiology, UZ Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, My FetUZ Fetal Research Center, KU Leuven, Leuven, Belgium
| | - Simen Vergote
- Department of Development and Regeneration, My FetUZ Fetal Research Center, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium
| | - Doaa Emam
- Department of Development and Regeneration, My FetUZ Fetal Research Center, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium
- Department Obstetrics and Gynecology, University Hospitals Tanta, Tanta, Egypt
| | - Johannes van der Merwe
- Department of Development and Regeneration, My FetUZ Fetal Research Center, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium
| | - Elina Ghijsens
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Luc Joyeux
- Department of Development and Regeneration, My FetUZ Fetal Research Center, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium
- Department of Pediatric Surgery, Great Ormond Street Hospital, University College London Hospitals, London, United Kingdom
| | - David Basurto
- Department of Development and Regeneration, My FetUZ Fetal Research Center, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium
| | - Marc Van de Velde
- Department of Anesthesiology, UZ Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, My FetUZ Fetal Research Center, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium
- Institute for Women's Health, University College London, London, United Kingdom
| | - Steffen Rex
- Department of Anesthesiology, UZ Leuven, Leuven, Belgium,
- Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium,
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Reduced Port Surgery for a Pregnant Woman With Strangulated Small Bowel Obstruction: A Case Report. Int Surg 2020. [DOI: 10.9738/intsurg-d-17-00129.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction
Intestinal obstruction in pregnancy is very rare, but the maternal mortality rate and the fetal loss rate are high. Therefore, an early diagnosis and appropriate treatments for small bowel obstructions (SBOs) during pregnancy are crucial for the mothers and fetuses. On the other hand, laparoscopic surgeries are widely used in pregnant patients, although laparoscopic surgeries for SBOs can have higher risks of complications. Then, reduced port surgery (RPS) can reduce the risk of intestinal injury by minimizing the number of ports the operator could not control alone. There is no previous report of RPS for SBOs in pregnant patients. We report on a pregnant patient with a strangulated SBO treated with RPS without complications.
Case presentation
A 37-year-old Japanese pregnant woman complaining of severe abdominal pain was admitted by ambulance. Her gestational age was 9 weeks. Her medical history included surgery for acute perforated appendicitis and deep vein thrombosis due to anti-thrombin III deficiency. Abdominal computed tomography revealed a strangulated SBO. We performed RPS and the cause of strangulated SBO was a string at the postoperative site of the appendectomy. The ischemic region of the small bowel recovered after we cut the string and released the adhesion. The patient's postoperative course was uneventful and the fetus was not harmed.
Conclusion
This is the first report of RPS performed for the pregnant patient with the strangulated SBO. Our findings indicate that RPS is a feasible treatment for strangulated SBOs in pregnant women.
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Cai YL, Yang SS, Peng DZ, Jia QB, Li FY, Ye H, Cheng NS. Laparoscopic appendectomy is safe and feasible in pregnant women during second trimester: A retrospective study in a top-level Chinese center. Medicine (Baltimore) 2020; 99:e21801. [PMID: 32872081 PMCID: PMC7437783 DOI: 10.1097/md.0000000000021801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Acute appendicitis (AA) is the most common nonobstetric surgical emergency during pregnancy. According to the current guidelines and meta-analyses, traditional open appendectomy (OA) is still recommended for pregnant patients over laparoscopic appendectomy (LA), which might be associated with higher rates of fetal loss. Previous studies and experiences indicated that LA might be safe in the second trimester of pregnancy. The current study aimed to evaluate the safety and feasibility of LA in pregnant women during the second trimester.At our institution, a retrospective study was conducted with pregnant patients who underwent LA or OA during the second trimester between January 2016 and August 2018.A total of 48 patients were enrolled. Of them, 12 were managed with laparoscopy and 36 with the open approach. We found that the LA group had higher BMIs than the OA group (4.0 ± 4.3 vs 21.5 ± 2.9, P = .031). The financial results showed that the average daily medical costs for patients who underwent LA was higher than those who underwent OA (444 ± 107 US$ vs 340 ± 115 US$, P = .009), while the total cost of hospitalization was comparable between the 2 approaches. The perioperative and obstetric outcomes were comparable between LA and OA. In each group, only 1 patient had fetal loss. No "Yinao" was found in any of the patients in the LA group.In this study, with the proven advantages of the laparoscopic techniques, LA was found to be safe and feasible for pregnant women during the second trimester.
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Yang Z, Sun F, Ai S, Wang J, Guan W, Liu S. Meta-analysis of studies comparing conservative treatment with antibiotics and appendectomy for acute appendicitis in the adult. BMC Surg 2019; 19:110. [PMID: 31412833 PMCID: PMC6694559 DOI: 10.1186/s12893-019-0578-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Appendectomy is considered the first treatment choice for appendicitis. However, controversy exists since conservative therapy is associated with fewer complications than appendectomy for patients with acute appendicitis (AA). This meta-analysis aimed to compare the outcomes between conservative therapy and appendectomy in the management of adult AA. METHODS A literature search was performed to screen eligible clinical studies. Subgroup analyses of the uncomplicated population, complicated population and mixed population of randomized clinical trials were subsequently performed. Clinical outcomes included the overall effective rate of treatment, complication rate, relapse rate (reoperation rate) and overall length of stay (LOS). RESULTS Eleven trials totalling 2751 patients (conservative = 1463, appendectomy = 1288) were analysed. Patients receiving conservative treatment had a lower overall effective rate (OR: 0.11 ~ 0.17) and complication rate (OR: 0.21 ~ 0.51). The conservative group had a higher reoperation rate (5.6, 95% CI: 3.1% ~ 10.2%) than the appendectomy group (OR: 9.58 ~ 14.29). Conservative treatment was associated with a shorter overall length of stay (0.47 day, 95% CI: 0.45 ~ 0.5 day) than appendectomy. CONCLUSIONS For both uncomplicated and complicated adult AA, non-operative management with antibiotics was associated with significantly fewer complications and a shorter length of stay but a lower effective rate and higher relapse rate.
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Affiliation(s)
- Zhengyang Yang
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan RD, Nanjing, 210008, China
| | - Feng Sun
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan RD, Nanjing, 210008, China
| | - Shichao Ai
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan RD, Nanjing, 210008, China
| | - Jiafeng Wang
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan RD, Nanjing, 210008, China
| | - Wenxian Guan
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan RD, Nanjing, 210008, China.
| | - Song Liu
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan RD, Nanjing, 210008, China.
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Devroe S, Bleeser T, Van de Velde M, Verbrugge L, De Buck F, Deprest J, Devlieger R, Rex S. Anesthesia for non-obstetric surgery during pregnancy in a tertiary referral center: a 16-year retrospective, matched case-control, cohort study. Int J Obstet Anesth 2019; 39:74-81. [DOI: 10.1016/j.ijoa.2019.01.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 12/22/2018] [Accepted: 01/07/2019] [Indexed: 11/28/2022]
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Sazhin AV, Kurtser MA, Konoplyannikov AG, Ivakhov GB, Panin AV, Son DA, Shulyak GD, Serebrennikova YA. [Complicated appendicitis during pregnancy]. Khirurgiia (Mosk) 2019:15-23. [PMID: 31120442 DOI: 10.17116/hirurgia201904115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To analyze incidence, diagnosis and treatment of complicated appendicitis in pregnant women and to determine the optimal surgical approach. MATERIAL AND METHODS Retrospective cohort analysis included 338 pregnant women who underwent appendectomy in 2012-2016. Complicated appendicitis (abscess, local or common peritonitis and their combinations) was diagnosed in 22 cases. The main perioperative variables (duration of the disease, time of surgery, length of hospital-stay, incidence of wound complications, etc.), clinical and laboratory symptoms, results of ultrasound diagnosis and pregnancy outcomes were analyzed. Statistical analysis was carried out in Stata 14.2. Fisher's exact test, Mann-Whitney-Wilcoxon's U-test and multivariate regression analysis were used to compare data. RESULTS The incidence of complicated appendicitis in pregnant women was 6.51%. There are no clinical symptoms which would be significantly more common in complicated appendicitis during pregnancy. Complicated course prolongs surgery and hospital-stay, however duration of postoperative analgesia depends on surgical technique as a rule. There were 27% of laparoscopic interventions that is lower compared with women with uncomplicated appendicitis. The percentage of conversions was higher too. CONCLUSION Clinical diagnosis of complicated appendicitis during pregnancy even by using of ultrasound is not satisfactory and requires the involvement of other objective methods, such as MRI. Laparoscopic intervention is not contraindicated in pregnant women with complicated appendicitis and determine better treatment outcomes than open surgery.
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Affiliation(s)
- A V Sazhin
- Pirogov Russian National Research Medical University of Ministry of Health of Russia, Moscow, Russia
| | - M A Kurtser
- Pirogov Russian National Research Medical University of Ministry of Health of Russia, Moscow, Russia; Clinical Hospital of Lapino 'Mother and Child', Moscow region, Lapino, Russia
| | - A G Konoplyannikov
- Pirogov Russian National Research Medical University of Ministry of Health of Russia, Moscow, Russia
| | - G B Ivakhov
- Pirogov Russian National Research Medical University of Ministry of Health of Russia, Moscow, Russia
| | - A V Panin
- Clinical Hospital of Lapino 'Mother and Child', Moscow region, Lapino, Russia
| | - D A Son
- Pirogov Russian National Research Medical University of Ministry of Health of Russia, Moscow, Russia
| | - G D Shulyak
- Pirogov Russian National Research Medical University of Ministry of Health of Russia, Moscow, Russia
| | - Yu A Serebrennikova
- Pirogov Russian National Research Medical University of Ministry of Health of Russia, Moscow, Russia
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Lee SH, Lee JY, Choi YY, Lee JG. Laparoscopic appendectomy versus open appendectomy for suspected appendicitis during pregnancy: a systematic review and updated meta-analysis. BMC Surg 2019; 19:41. [PMID: 31023289 PMCID: PMC6482586 DOI: 10.1186/s12893-019-0505-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recently, laparoscopic appendectomies (LAs) have been widely performed instead of open appendectomies (OAs) during pregnancy. However, concerns about the safety of LA during pregnancy remain. This systematic review and meta-analysis aimed to evaluate the current evidence relating to the safety of LA versus OA for suspected appendicitis during pregnancy. METHODS Comprehensive literature searches were conducted using the PubMed, EMBASE, and Cochrane Library databases to identify articles describing LA versus OA in pregnancy, without restrictions regarding the publication date. The primary endpoints were fetal loss and preterm delivery. RESULTS After screening 801 studies, 22 comparative cohort studies were included in the analysis, which involved 4694 women, of whom 905 underwent LAs and 3789 underwent OAs. Fetal loss was significantly higher among those who underwent LAs compared with those who underwent OAs, and the pooled odds ratio (OR) was 1.72 (95% confidence interval [CI]: 1.22-2.42) without heterogeneity. The sensitivity analysis showed that the effect size was influenced by one of the studies, because its removal resulted in there being no significant difference between LA and OA with respect to the risk of fetal loss (OR 1.163, 95% CI: 0.68-1.99; P = 0.581). A significant difference was not evident between LA and OA with respect to preterm delivery (OR 0.76, 95% CI: 0.51-1.15), a result that did not change following the sensitivity analysis. The patients who underwent LA had shorter hospital stays (mean difference - 1.01, 95% CI: -1.61--0.41) and a lower wound infection risk (OR 0.40, 95% CI: 0.21-0.76) compared with those who underwent OA. CONCLUSION It is not reasonable to conclude that LA in pregnant women might be associated with a greater risk of fetal loss. The difference between LA and OA with respect to preterm delivery was not significant.
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Affiliation(s)
- Seung Hwan Lee
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jin Young Lee
- Department of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Yoon Young Choi
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Frountzas M, Nikolaou C, Stergios K, Kontzoglou K, Toutouzas K, Pergialiotis V. Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies. Ann R Coll Surg Engl 2019; 101:235-248. [PMID: 30855978 PMCID: PMC6432950 DOI: 10.1308/rcsann.2019.0011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2018] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Acute appendicitis is a common and serious situation during pregnancy, because of the increased risk of fetal loss and perforation in the third trimester, as well as a diagnostic difficulty. During recent years laparoscopic approach has been introduced to clinical practice with encouraging results. The purpose of this meta-analysis is to compare the surgical and obstetrical outcomes between laparoscopic and open appendectomy during pregnancy. MATERIALS AND METHODS MEDLINE, SCOPUS, Clinicaltrials.gov, CENTRAL and Google Scholar were searched for studies reporting on postoperative outcomes between laparoscopic and open appendectomy during pregnancy. The random effects model (DerSimonian-Laird) was used to calculate pooled effect estimates when high heterogeneity was encountered, otherwise the fixed-effects (Mantel-Haenszel) model was implemented. RESULTS Twenty-one studies that enrolled 6276 pregnant women are included in the present meta-analysis. Of these women, 1963 underwent laparoscopic appendectomy and 4313 underwent an open appendectomy. Women who underwent laparoscopic appendectomy demonstrated an increase in fetal loss risk, while neonates of women that underwent open appendectomy presented decreased Apgar score at five minutes after birth. All the rest outcomes were similar between the two groups. The time that each study took place seemed to affect the comparison of birth weight and postoperative hospital stay between the two groups. CONCLUSION Laparoscopic appendectomy seems to be a relatively safe therapeutic option in pregnancy when it is indicated. Thus, it should be implemented in clinical practice, always considering the experience of the surgeon in such procedures. Nevertheless, the need of new studies to enhance this statement remains crucial.
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Affiliation(s)
- M Frountzas
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Greece
| | - C Nikolaou
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Greece
| | - K Stergios
- General Surgery, Watford General Hospital, Watford, UK
| | - K Kontzoglou
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Greece
- 2nd Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - K Toutouzas
- 1st Department of Propedeutic Surgery, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - V Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Greece
- 2nd Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
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Ball E, Waters N, Cooper N, Talati C, Mallick R, Rabas S, Mukherjee A, Sri Ranjan Y, Thaha M, Doodia R, Keedwell R, Madhra M, Kuruba N, Malhas R, Gaughan E, Tompsett K, Gibson H, Wright H, Gnanachandran C, Hookaway T, Baker C, Murali K, Jurkovic D, Amso N, Clark J, Thangaratinam S, Chalhoub T, Kaloo P, Saridogan E. Evidence-Based Guideline on Laparoscopy in Pregnancy: Commissioned by the British Society for Gynaecological Endoscopy (BSGE) Endorsed by the Royal College of Obstetricians & Gynaecologists (RCOG). Facts Views Vis Obgyn 2019; 11:5-25. [PMID: 31695854 PMCID: PMC6822954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Laparoscopy is widely utilised to diagnose and treat acute and chronic, gynaecological and general surgical conditions. It has only been in recent years that laparoscopy has become an acceptable surgical alternative to open surgery in pregnancy. To date there is little clinical guidance pertaining to laparoscopic surgery in pregnancy. This is why the BSGE commissioned this guideline. MEDLINE, EMBASE, CINAHL and the Cochrane library were searched up to February 2017 and evidence was collated and graded following the NICE-approved process. The conditions included in this guideline are laparoscopic management of acute appendicitis, acute gall bladder disease and symptomatic benign adnexal tumours in pregnancy. The intended audience for this guideline is obstetricians and gynaecologists in secondary and tertiary care, general surgeons and anaesthetists. However, only laparoscopists who have adequate laparoscopic skills and who perform complex laparoscopic surgery regularly should undertake laparoscopy in pregnant women, since much of the evidence stems from specialised centres.
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Affiliation(s)
| | - N Waters
- Royal Surrey County Hospital NHS Trust
| | | | | | - R Mallick
- Brighton and Sussex University Hospitals NHS Trust
| | - S Rabas
- Queen’s Hospital London and King George Hospital
| | | | | | | | | | | | | | - N Kuruba
- Norfolk and Norwich University Hospital
| | | | | | | | - H Gibson
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - H Wright
- North Manchester General Hospital
| | | | | | | | - K Murali
- Salisbury District and General Hospital
| | | | - N Amso
- Cardiff University School of Medicine
| | | | | | | | - P Kaloo
- Gloucestershire Hospitals NHS Foundation Trust
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Chakraborty J, Kong JC, Su WK, Gourlas P, Gillespie C, Slack T, Morris B, Lutton N. Safety of laparoscopic appendicectomy during pregnancy: a systematic review and meta-analysis. ANZ J Surg 2019; 89:1373-1378. [PMID: 30756460 DOI: 10.1111/ans.14963] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/11/2018] [Accepted: 10/14/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acute appendicitis is the most common non-obstetric surgical presentation during pregnancy. There were concerns that laparoscopic appendicectomy increases the risk of foetal loss compared to an open approach. Therefore, with recent advances in perioperative care, it is likely the risk has changed. Here, we performed an updated meta-analysis assessing the safety of laparoscopic appendicectomy in pregnant women. METHODS A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was undertaken between 2000 and 2017 on Ovid Medline and Embase. The primary outcome measures were foetal loss and preterm delivery, whereas secondary outcome measures were operative time and hospital length of stay. A random-effect model was performed to pool odds ratio (OR) and standardized mean difference (SMD). RESULTS Seventeen observational studies were included, with 1886 patients in the laparoscopic and 4261 patients in the open group. Comparing laparoscopic versus open appendicectomy, there were 54 (5.96%) and 136 (3.73%) foetal losses, respectively. However, preterm delivery was much higher in the open approach (8.99%) compared to laparoscopic approach (2.84%). Pooled OR for foetal loss was 1.84 (95% confidence interval (CI) 1.31-2.58, P < 0.001), whereas OR for preterm delivery was 0.39 (95% CI 0.27-0.55, P < 0.001). There was no significant difference between both approaches for operative time (SMD -0.07; 95% CI -0.43 to 0.30, P = 0.71) or hospital length of stay (SMD -0.34; 95% CI -0.83 to 0.16, P = 0.18). CONCLUSION In a pooled analysis of level III evidence, laparoscopic appendicectomy posed a higher risk of foetal loss but lower risk of preterm delivery. Caution and informed consent are crucial when offering a laparoscopic approach.
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Affiliation(s)
- Joy Chakraborty
- Department of Colorectal Surgery, Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Joseph Cherng Kong
- Department of Colorectal Surgery, Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Wai Kin Su
- Department of Colorectal Surgery, Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Peter Gourlas
- Department of Colorectal Surgery, Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Christopher Gillespie
- Department of Colorectal Surgery, Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Timothy Slack
- Department of Colorectal Surgery, Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Bradley Morris
- Department of Colorectal Surgery, Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nicholas Lutton
- Department of Colorectal Surgery, Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Zachariah SK, Fenn M, Jacob K, Arthungal SA, Zachariah SA. Management of acute abdomen in pregnancy: current perspectives. Int J Womens Health 2019; 11:119-134. [PMID: 30804686 PMCID: PMC6371947 DOI: 10.2147/ijwh.s151501] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Acute abdomen in pregnancy represents a unique diagnostic and therapeutic challenge. Acute abdominal pain in pregnancy can occur due to obstetric factors as well for reasons that are unrelated to pregnancy. The diagnostic approach of acute abdomen during pregnancy can be tricky owing to the altered clinical presentations brought about by the anatomical and physiological changes of gestation along with the reluctance to use certain radiological investigations for fear of harming the fetus. Delay in diagnosis and treatment can lead to adverse outcomes for both the mother and fetus. In this article, we attempt to review and discuss the various etiologies, the current concepts of diagnosis, and treatment, with a view to developing a strategy for timely diagnosis and management of pregnant women presenting with acute abdominal pain.
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Affiliation(s)
- Sanoop Koshy Zachariah
- Department of General, Gastrointestinal & Laparoscopic Surgery, MOSC Medical College, Kolenchery Cochin, Cochin 682311, India,
| | - Miriam Fenn
- Department of Obstetrics and Gynecology, MOSC Medical College, Kolenchery Cochin, Cochin 682311, India
| | - Kirthana Jacob
- Department of Obstetrics and Gynecology, MOSC Medical College, Kolenchery Cochin, Cochin 682311, India
| | - Sherin Alias Arthungal
- Department of General, Gastrointestinal & Laparoscopic Surgery, MOSC Medical College, Kolenchery Cochin, Cochin 682311, India,
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Prodromidou A, Machairas N, Kostakis ID, Molmenti E, Spartalis E, Kakkos A, Lainas GT, Sotiropoulos GC. Outcomes after open and laparoscopic appendectomy during pregnancy: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2018; 225:40-50. [PMID: 29656140 DOI: 10.1016/j.ejogrb.2018.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/06/2018] [Accepted: 04/08/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Acute appendicitis is the most prevalent cause of non-obstetrical surgical disease during pregnancy. There is no consensus on the optimal surgical management of acute appendicitis in pregnancy. Our aim is to identify surgical and obstetrical outcomes of laparoscopic (LA) and open approach (OA) in pregnant patients with acute appendicitis. STUDY DESIGN Medline, Scopus, Google Scholar, Cochrane CENTRAL Register of Controlled Trials and Clinicaltrials.gov databases were searched for articles published up to May 2017, along with the references of all articles. Prospective and retrospective trials reporting outcomes among pregnant women undergoing laparoscopic and open appendectomy were included. Of the 493 records screened, 20 were eligible for meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Statistical meta-analysis was performed using the RevMan 5.3 software. RESULTS A total of 6210 pregnant women from twenty studies were included in meta-analysis. Laparoscopic appendectomy was associated with significantly lower overall complication rates and shorter hospital stays (1835 patients OR 0.48 95% CI 0.29, 0.80 p = 0.005). While the open appendectomy group showed prolongation of gestational age for term deliveries, laparoscopic appendectomy patients had higher rates of fetal loss (543 patients MD -0.46 weeks 95% CI-0.87 to -0.04, p = 0.03 and 4867 patients OR 1.82 95% CI 1.30 to 2.57, p = 0.0006, respectively). CONCLUSIONS Current literature remains inconclusive on the optimal approach of appendectomy in pregnant women. Further larger-volume studies are needed in order to elucidate the critical effect of laparoscopic appendectomy on fetal loss rates.
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Affiliation(s)
- Anastasia Prodromidou
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | - Ernesto Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, New York, USA
| | - Eleftherios Spartalis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Athanasios Kakkos
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Liege, Liege, Belgium
| | | | - Georgios C Sotiropoulos
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Gorter RR, Eker HH, Gorter-Stam MAW, Abis GSA, Acharya A, Ankersmit M, Antoniou SA, Arolfo S, Babic B, Boni L, Bruntink M, van Dam DA, Defoort B, Deijen CL, DeLacy FB, Go PM, Harmsen AMK, van den Helder RS, Iordache F, Ket JCF, Muysoms FE, Ozmen MM, Papoulas M, Rhodes M, Straatman J, Tenhagen M, Turrado V, Vereczkei A, Vilallonga R, Deelder JD, Bonjer J. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc 2016; 30:4668-4690. [PMID: 27660247 PMCID: PMC5082605 DOI: 10.1007/s00464-016-5245-7] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/09/2016] [Indexed: 02/08/2023]
Abstract
Unequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis.
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Affiliation(s)
- Ramon R Gorter
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
- Department of Pediatric Surgery, VU University Medical Centre, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Hasan H Eker
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Gabor S A Abis
- Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Amish Acharya
- Department of Surgery, St Mary's Hospital, London, UK
| | - Marjolein Ankersmit
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Stavros A Antoniou
- Department of Surgery, Center for Minimally Invasive Surgery, Neuwerk Hospital, Mönchengladbach, Germany
- Department of Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - Simone Arolfo
- Department of Surgery, University of Torino, Torino, Italy
| | - Benjamin Babic
- Department of Surgery, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Luigi Boni
- Department of Surgery, Minimally Invasive Surgery Research Center, University of Insubria, Varese, Italy
| | - Marlieke Bruntink
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | | | - Barbara Defoort
- Department of Surgery, Maria Middelares Ghent, Ghent, Belgium
| | - Charlotte L Deijen
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - F Borja DeLacy
- Department of Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Peter Mnyh Go
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Florin Iordache
- Department of Surgery, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | | | - Filip E Muysoms
- Department of Surgery, Maria Middelares Ghent, Ghent, Belgium
| | - M Mahir Ozmen
- Department of Surgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Michail Papoulas
- Department of Surgery, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Michael Rhodes
- Department of Surgery, Stepping Hill Hospital, Stockport, UK
| | - Jennifer Straatman
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mark Tenhagen
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Victor Turrado
- Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Andras Vereczkei
- Department of Surgery, Medical School University of Pécs, Pecs, Hungary
| | - Ramon Vilallonga
- Department of Surgery, University Hospital Vall Hebrón, Barcelona, Spain
| | - Jort D Deelder
- Department of Surgery, Noordwest Clinics Alkmaar, Alkmaar, The Netherlands
| | - Jaap Bonjer
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
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Could laparoscopic appendectomy in pregnant women affect obstetric outcomes? A multicenter study. Int J Colorectal Dis 2016; 31:1475-81. [PMID: 27072934 DOI: 10.1007/s00384-016-2584-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to compare the perioperative and obstetric outcomes of pregnant women between laparoscopic surgery and open surgery and to evaluate the predictive factors for overall obstetric outcomes. METHODS We retrospectively reviewed the medical records of pregnant women who underwent appendectomy between January 2008 and June 2015 at six hospitals affiliated to Hallym University. RESULTS Eighty patients were evaluated. Twenty-four underwent laparoscopic appendectomy (LA) and 56 underwent open appendectomy (OA). There were no significant differences in the patients' characteristics and gestational age at surgery between the two groups. Operation time, time to flatus, and time to soft food intake were similar in both groups. The length of stay was shorter in the LA group than in the OA group (5.1 vs 8.1 days, P = 0.044). Gestational age at delivery, birth weight, and delivery type were similar in both groups. There was no significant difference in overall obstetric poor outcome (20.8 vs 14.3 %, P = 0.516), including preterm delivery (8.3 vs 7.1 %, P = 1.000) and fetal loss (12.5 vs 7.1 %, P = 0.350). Multivariable analysis revealed that fever >38 °C (P = 0.022) and maternal age (P = 0.044) were independent predictors for the overall poor outcomes. CONCLUSIONS LA was associated with shorter length of stay compared with OA, but perioperative and obstetric outcomes were similar with both procedures. LA can be safely performed in pregnant women in any trimester.
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Béranger-Gibert S, Sakly H, Ballester M, Rockall A, Bornes M, Bazot M, Daraï E, Thomassin-Naggara I. Diagnostic Value of MR Imaging in the Diagnosis of Adnexal Torsion. Radiology 2016; 279:461-70. [DOI: 10.1148/radiol.2015150261] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Barber-Millet S, Bueno Lledó J, Granero Castro P, Gómez Gavara I, Ballester Pla N, García Domínguez R. Update on the management of non-obstetric acute abdomen in pregnant patients. Cir Esp 2016; 94:257-65. [PMID: 26875476 DOI: 10.1016/j.ciresp.2015.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 12/29/2022]
Abstract
Acute abdomen is a rare entity in the pregnant patient, with an incidence of one in 500-635 patients. Its appearance requires a quick response and an early diagnosis to treat the underlying disease and prevent maternal and fetal morbidity. Imaging tests are essential, due to clinical and laboratory masking in this subgroup. Appendicitis and complicated biliary pathology are the most frequent causes of non-obstetric acute abdomen in the pregnant patient. The decision to operate, the timing, and the surgical approach are essential for a correct management of this pathology. The aim of this paper is to perform a review and update on the diagnosis and treatment of non-obstetric acute abdomen in pregnancy.
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Affiliation(s)
| | - José Bueno Lledó
- Servicio de Cirugía, Hospital Universitari i Politècnic La Fe, Valencia, España
| | | | | | - Neus Ballester Pla
- Servicio de Cirugía, Hospital Universitari i Politècnic La Fe, Valencia, España
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31
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Popa D, Soltes M, Uranues S, Fingerhut A. Are There Specific Indications for Laparoscopic Appendectomy? A Review and Critical Appraisal of the Literature. J Laparoendosc Adv Surg Tech A 2015; 25:897-902. [PMID: 26575247 DOI: 10.1089/lap.2014.0624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Dorin Popa
- University of Medicine and Pharmacy “Carol Davila” Bucharest, University Emergency Hospital, Bucharest, Romania
| | - Marek Soltes
- I. Chirurgicka Klinika, University of Pavol Jozef Safarik, Kosice, Slovak Republic
| | - Selman Uranues
- Section of Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Abe Fingerhut
- Section of Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
- First Department of Surgery, University of Athens, Hippokration University Hospital, Athens, Greece
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32
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Acute appendicitis in pregnancy: Case series and review. North Clin Istanb 2015; 3:60-63. [PMID: 28058387 PMCID: PMC5175079 DOI: 10.14744/nci.2015.96530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 06/06/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: Acute appendicitis is one of the most common acute surgical pathology we encountered. In this study we investigated our pregnant cases of appendicitis, and reviewed literature. METHODS: A total of 21 pregnant women who underwent appendectomy with the initial diagnosis of acute appendicitis in Istanbul Medeniyet University Clinics of General Surgery between January 2012, and December 2014 were retrospectively analyzed. The patients’s ages, trimesters, complaints, abdominal examination, laboratory, and ultrasonographic findings, surgical techniques, complications and hospital stay were noted. RESULTS: The patients were in their first (n=12; 57.1%), second (n=5; 23.8%), and third trimesters (n=4; 19.0%) of their pregnancies Median age was 23.9 years. All of the patients had abdominal pain. Median value of WBC count was 13.297/mm³. Ultrasound was positive in 12 patients (57.1%). In 14 (66.6%) patients McBurney incision, and in 6 (28.6%) cases right paramedian incision were used. One patient (4.8%) underwent laparoscopic appendectomy. Nineteen cases were acute appendicitis (90.5%), and two cases were perforated appendicitis (9.5%). Average hospital stay was 3.8 days. Two cases with perforated acute appendicitis developed wound infection and treated conservatively. There were no fetomaternal mortality. CONCLUSION: Physiologically anatomic and biochemical changes occurring during pregnancy can delay the diagnosis of acute appendicitis threaten the lives of both the mother and the fetus Therefore, rapid diagnosis and appropriate treatment convey importance.
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Laparoscopic appendectomy and cholecystectomy versus open: a study in 1999 pregnant patients. Surg Endosc 2015; 30:593-602. [PMID: 26091987 DOI: 10.1007/s00464-015-4244-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 05/18/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND When pregnant patients require surgery, whether to perform an operation open or laparoscopic is often debated. We evaluated the impact of laparoscopy for common general surgical problems in pregnancy to determine safety and trends in operative approach over time. METHODS Pregnant patients undergoing appendectomy or cholecystectomy were identified using the National Surgical Quality Improvement Program (NSQIP) database. We analyzed demographics, operative characteristics, and outcomes. Univariate comparison and multivariate regression analysis (MVA) were performed adjusting for confounding factors: age, body mass index (BMI), diabetes, and smoking, and an additional MVA was performed for perforated cases. RESULTS A total of 1999 pregnant patients between 2005 and 2012 were evaluated. Of 1335 appendectomies, 894 were performed laparoscopically (LA) and 441 open (OA). For 664 cholecystectomies, 606 were laparoscopic (LC) and 58 open (OC). There were no deaths. For LA versus OA, patient characteristics were not different {age: 27.7 vs. 28.2 years, p = 0.19; diabetes: 1.8 vs. 0.9%, p = 0.24; smoking: 19 vs. 16.1%, p = 0.2} except for BMI (27.9 vs. 28.4 kg/m(2); p = 0.03). LA had shorter operative times (ORT), length of stay (LOS), and fewer postoperative complications compared to OA. In MVA, difference between approaches remained statistically significant for ORT (<0.0001), LOS (<0.01), and wound complications (<0.01). MVA was performed for perforated cases alone: LA had equal ORT (p = 0.19) yet shorter LOS (p = <0.001). The majority of LA were performed in the last 4 years versus the first 4 years (61 vs. 39%, p < 0.001). For LC versus OC, patient characteristics were not different: age (28.3 vs. 28.7 years; p = 0.33), BMI (31.4 vs. 33.2 kg/m(2), p = 0.25), diabetes (2.8 vs. 3.5%, p = 0.68), and smoking (21.1 vs. 25.9%, p = 0.4). LC had a shorter ORT, LOS, and fewer postoperative complications than OC. In MVA, the difference between approaches remained statistically significant for ORT (<0.0001), LOS (<0.0001), and minor complications (<0.01). In MVA for cholecystitis with perforation, no difference was seen for LOS, ORT, or postoperative complications (p > 0.05). The percentage of LC cases appeared to increase over time (89 vs. 93%, p = 0.06). CONCLUSION While fetal events are unknown, LA and LC in pregnant patients demonstrated shorter ORT, LOS, and reduced complications and were performed more frequently over time. Even in perforated cases, laparoscopy appears safe in pregnant patients.
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