Single-port laparoscopic appendectomy for acute appendicitis during pregnancy

Non-obstetric surgery during pregnancy and the effects on maternal and fetal outcomes: A systematic review

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.

A brief overview of single-port laparoscopic appendectomy as an optimal surgical procedure for patients with acute appendicitis: still a long way to go

Single-port laparoscopic appendectomy (SPLA) has become a good alternative to the traditional surgical treatment of acute appendicitis, due to its advantages of small incision, mild postoperative pain, short hospital stay, and good cosmetic effect. However, the further application of SPLA has been restricted by its relatively long operating time, high level of operating difficulty, and increased equipment and technical requirements. Clinical teams worldwide have attempted to improve and optimize SPLA technical protocols and equipment to maintain stable intraoperative pneumoperitoneal pressure, improve the 'triangle relationship' of operating angles, and develop new surgical procedures with less trauma and higher cost-effectiveness. Here, new SPLA techniques reported over the past decade are reviewed and compared, with the aim of providing new insights into technical improvements, equipment upgrades and clinical studies in the coming years.

Single-Port Laparoscopic Surgery for Adnexal Mass Removal During Pregnancy: The Initial Experience of a Single Institute

OBJECTIVE

Single-port laparoscopy has become a feasible and safe approach for the management of benign adnexal masses during pregnancy. To our knowledge, there are few reports on the feasibility and safety of single-port laparoscopy for adnexal mass removal during pregnancy. Our study reports the use of single-port laparoscopy in adnexal mass removal during pregnancy in our hospital.

METHODS

We included 10 cases of single-port laparoscopic surgery for adnexal mass removal during pregnancy in the West China Second University Hospital between January 2017 and March 2020. Median values were found using SPSS20. When the p-value was <0.05, the median and interquartile range were used. All patients provided informed consent.

RESULTS

The following median values were recorded: surgical time, 112.50 min; blood loss, 25 ml; postoperative hospital stay, 3 days; postoperative pain [visual analog scale (VAS)] at 6 h, 3; and postoperative pain (VAS) at 24 h, 2. Our study reported no postoperative spontaneous abortions. There was one preterm birth.

CONCLUSION

Single-port laparoscopy appears to be safe for both the mother and the fetus.