Division of Acute Care Surgery, North Estonia Medical Centre, J. Sütiste Tee 19, 13419, Tallinn, Estonia.
Faculty of Medicine, University of Tartu, Tartu, Estonia.
Surg Endosc. 2023 Aug;37(8):6025-6031. doi: 10.1007/s00464-023-10075-0. Epub 2023 Apr 26.
Laparoscopic appendectomy (LA) is the standard treatment for acute appendicitis (AA) in general population. However, the safety of LA during pregnancy has remained a matter of debate. The purpose of this study was to compare surgical and obstetrical outcomes in pregnant women who underwent LA vs. open appendectomy (OA) for AA. We hypothesized that LA results in improved surgical and obstetric outcomes during pregnancy.
Using a nationwide claim-based database in Estonia, a retrospective review of all cases of pregnant women undergoing OA or LA for AA from 2010 to 2020 was performed. Patient characteristics, surgical and obstetrical outcomes were analyzed. Primary outcomes were preterm delivery, fetal loss and perinatal mortality. Secondary outcomes included operative time, hospital length of stay (HLOS) and 30-day postoperative complications.
Overall, 102 patients were included of whom 68 (67%) underwent OA and 34 patients (33%) LA, respectively. Patients in LA cohort had a significantly shorter length of pregnancy in terms of gestational weeks when compared to OA cohort (12 weeks versus 17 weeks, p = 0.002). Most of the patients in their 3 trimester pregnancy were subjected to OA. Operative time in LA cohort was shorter than in OA cohort (34 min. versus 44 min., p = 0.038). HLOS in LA cohort was shorter than in OA cohort (2.1 days versus 2.9 days, p = 0.016). There were no differences between OA and LA cohorts in terms of surgical complications or obstetrical outcomes.
Laparoscopic appendectomy for acute appendicitis was associated with a significantly shorter operative time and a shorter hospital length of stay while open and laparoscopic appendectomy cohorts experienced comparable obstetrical outcomes. Our findings support the laparoscopic approach for acute appendicitis in pregnancy.
腹腔镜阑尾切除术（LA）是一般人群中急性阑尾炎（AA）的标准治疗方法。然而，LA 在怀孕期间的安全性仍然存在争议。本研究的目的是比较孕妇行 LA 与开腹阑尾切除术（OA）治疗 AA 的手术和产科结局。我们假设 LA 可改善怀孕期间的手术和产科结局。
使用爱沙尼亚全国基于索赔的数据库，回顾性分析了 2010 年至 2020 年期间所有因 AA 行 OA 或 LA 的孕妇病例。分析了患者特征、手术和产科结局。主要结局为早产、胎儿丢失和围产儿死亡率。次要结局包括手术时间、住院时间（HLOS）和术后 30 天并发症。
总体而言，共纳入 102 例患者，其中 68 例（67%）行 OA，34 例（33%）行 LA。LA 组的妊娠周数明显短于 OA 组（12 周 vs. 17 周，p=0.002）。大多数处于 3 期妊娠的患者接受 OA。LA 组的手术时间短于 OA 组（34 分钟 vs. 44 分钟，p=0.038）。LA 组的 HLOS 短于 OA 组（2.1 天 vs. 2.9 天，p=0.016）。OA 和 LA 组在手术并发症或产科结局方面无差异。
腹腔镜阑尾切除术治疗急性阑尾炎与手术时间明显缩短和住院时间缩短相关，而开腹和腹腔镜阑尾切除术组的产科结局相当。我们的研究结果支持在怀孕期间采用腹腔镜治疗急性阑尾炎。
