M Frountzas1, C Nikolaou1, K Stergios2, K Kontzoglou1,3, K Toutouzas4, V Pergialiotis1,5. 1. Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens , Greece. 2. General Surgery, Watford General Hospital , Watford , UK. 3. 2nd Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece. 4. 1st Department of Propedeutic Surgery, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece. 5. 2nd Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens , Greece.
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.
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.
Authors: Jianzhou Yang; Shi Wu Wen; Daniel Krewski; Daniel J Corsi; Mark Walker; Donald Mattison; Ryan Moog; Doug McNair; Huiping Huang; Guihua Zhuang Journal: PLoS One Date: 2021-12-13 Impact factor: 3.240
Authors: J Vujic; K Marsoner; A H Lipp-Pump; P Klaritsch; H J Mischinger; P Kornprat Journal: BMC Pregnancy Childbirth Date: 2019-10-25 Impact factor: 3.007