Seok Ji Woong, Son Jungtack, Jung Kyung Uk, Lee Sung Ryol, Kim Hyung Ook
Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Minim Invasive Surg. 2021 Jun 15;24(2):68-75. doi: 10.7602/jmis.2021.24.2.68.
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.
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.
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.
In the laparoscopy age, appendectomy during pregnancy is safe and not associated with a significantly increased risk of postoperative complication.
急性阑尾炎是孕期非产科手术干预最常见的指征。在关于孕期急性阑尾炎最佳手术方式的争论中，腹腔镜手术似乎更胜一筹，其并发症发生率与开腹手术相似，但术后恢复时间更短。我们旨在比较全腹腔镜时代孕妇和非孕妇阑尾切除术的围手术期结局。
我们回顾性分析了2014年1月至2018年12月期间对18至45岁女性进行的556例非偶然阑尾切除术。为减少混杂效应，我们使用倾向评分法，考虑年龄、美国麻醉医师协会身体状况分类以及手术发现等变量；即阑尾炎是单纯性还是复杂性。倾向评分匹配后，将15例孕妇的结局与30例非孕妇的结局进行比较。
所有手术均采用腹腔镜进行。大多数孕妇病例处于孕早期和孕中期。倾向评分匹配前，孕妇组术后发病率显著更高；然而，匹配后这种显著性消失。两组的手术结局和与术后恢复相关的参数并无差异。两名孕早期患者在阑尾切除术后决定终止妊娠。一名孕中期患者发生早产，但自行缓解。没有其他产科不良结局。
在腹腔镜时代，孕期阑尾切除术是安全的，且术后并发症风险不会显著增加。
