Page 20 - WJOLS - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Safety and Efficacy of Laparoscopic Appendectomy in

Pregnant Females

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Mohamed F Amin , Morsi M Morsi , Mostafa M Elaidy , Mohamed S Badr , Ahmed M Farag , Safaa A Ibrahim
AbstrAct
Introduction: Laparoscopic surgery during pregnancy is contraindicated absolutely or relatively through the last decade; however, laparoscopic
appendectomy (LA) is still performed in pregnant women.
Materials and methods: Thirty-one pregnant females with a diagnosis of acute appendicitis and managed with LA or OA in the emergency
unit of the department of general surgery from June 2015 to December 2017.
Results: Eighteen patients underwent LA, while 13 patients underwent OA. No difference was noticed between both groups regarding the
operative duration, and fetal and maternal outcomes. However, the group of LA had faster first flatus and shorter inpatient duration than the
OA group.
Conclusion: Laparoscopic appendectomy is distinguished with efficacy and safety procedure throughout pregnancy and should be considered
a good replacement for open appendectomy.
Keywords: Appendectomy, Appendix, Laparoscopy, Pregnancy.
World Journal of Laparoscopic Surgery (2018): 10.5005/jp-journals-10033-1354

IntroductIon 1–3 Department of General Surgery, Zagazig University, Zagazig, Ash
Abdominal pain during pregnancy can be caused by variant Sharqia Governorate, Egypt
obstetric and nonobstetric pathologies that made diagnosing of 4–6 Department of Obstetrics and Gynecology, Zagazig University,
acute appendicitis during pregnancy quite a challenging problem. Zagazig, Ash Sharqia Governorate, Egypt
Limitations of CT scanning, physiological and anatomical changes Corresponding Author: Mohamed F Amin, Department of General
during pregnancy like physiological leukocytosis that could be Surgery, Zagazig University, Zagazig, Ash Sharqia Governorate, Egypt,
associated with pregnancy were also contributing factors for Phone: +20 1006255621, e-mail: dr_ruaa2000@yahoo.com
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difficult diagnosis. How to cite this article: Amin MF, Morsi MM, et al. Safety and Efficacy
Acute appendicitis is the most common nonobstetric condition of Laparoscopic Appendectomy in Pregnant Females. World J Lap Surg
requiring urgent surgical interference during pregnancy, with an 2018;11(3):128–131.
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estimated incidence between 0.05% and 0.13%. Source of support: Zagazig University

The rate of complicated appendicitis is much higher in pregnant Conflict of interest: None

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women. Delay in diagnosis increases the peril of complications to
the mother and fetus when acute appendicitis is suspected and an
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aggressive approach is recommended. assess pregnancy. All preoperative data including age, history of
Laparoscopic appendectomy during pregnancy is recom- previous section, gestation age at operation, and accuracy of the
mended in the first and second trimesters. Regarding the third diagnostic U/S were recorded. Also, all operative data including
trimester, there are no clear guidelines for performing laparoscopic the surgery duration, return time to normal bowel movement,
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appendectomy. The advantages of laparoscopic appendectomy inpatient length, postoperative complications, and final pathology
over open appendectomy include less postoperative pain, early were recorded. Obstetric and fetal data including the incidence of
discharge, less risk for wound infection, and giving feasibility for preterm labor, delivery type, and fetal mortality were also recorded.
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laparoscopic abdominal exploration.
In this study, we assessed the safety and efficacy of laparoscopic
appendectomy in pregnant females. lApAroscopIc AppendectoMy technIque In
pregnAnt FeMAles
MAterIAls And Methods The procedure was done in the supine position with a slight tilt
This retrospective was carried out in the emergency unit of the to the left side (20–30°). The procedure was done under general
General Surgery Department, Zagazig University from June 2015 anesthesia with maintained continuous end tidal volume CO
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to December 2017. Thirty-one pregnant women were included monitoring. Insertion of a Foley catheter was also done along
in the study. All of them were suffering from abdominal pain in with application of pneumatic compression devices on the legs.
the right lower quadrant with or without fever, suggesting acute A prophylactic antibiotic was administrated. Also, prophylactic
appendicitis. All patients underwent perioperative obstetric tocolysis was administrated. We performed the operation by
consultation and fetal monitoring. Complete blood count and pelvi- insertion of three ports. The first one, a supraumbilical 10 mm
abdominal ultrasound were carried out to confirm the diagnosis and port according to the size of the uterus (3–4 cm above the uterine

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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