Kerem KARAMAN, Metin ERCAN, Mehmet AZİRET, Fatih ALTINTOPRAK, Barış MANTOĞLU, Yeşim AKDENİZ, Cengiz KARACAER, Yasin Alper YILDIZ

Effectiveness of the laparoscopic appendectomy on second half of the pregnancy

Aim: Although the debate regarding fetal loss and preterm delivery continues, the use of laparoscopic appendectomy (LA) to treatpregnant women has gained legitimacy owing to the advantages it brings, such as less uterine manipulation, less postoperativepain, and an early return to normal daily activity. This present study aims to compare the impact of LA on women in early and lategestation periods with regard to surgical outcomes.Material and Methods: After scanning the files of 4,295 cases, 29 patients who underwent LA for acute appendicitis during pregnancywere enrolled in the study and were assessed retrospectively. The patients were divided into two groups: women with a gestationperiod less than 20 weeks (group 1; n=19) and those over 20 weeks (group 2; n=10). Data from these two groups, including patientperioperative characteristics and morbidity, were compared.Results: The results showed no statistical difference between the two groups. No statistically significant difference was detectedin terms of mean age, body mass index, length of hospital stay, operation time or median ASA score (p > 0.05). Moreover, meanINR (International normalized ratio), hemoglobin, hematocrit, white blood cell count, neutrophil-to-lymphocyte ratio, plateletto-lymphocyte ratio, red cell distribution width, platelet distribution width and histopathological examination of the appendicitisrevealed no statistical difference between the two groups (p > 0.05). Most importantly, comparison of surgical site infection (6.8%),intra-peritoneal collection (3.4%), fetal distress and preterm delivery rate (6.8%), and abortus imminens (3.4%) also showed nosignificant difference (P > 0.05). In this study, no fetal loss was recorded.Conclusion: The results of present study suggest that LA for acute appendicitis in pregnant women can be performed safely duringthe second half of pregnancy.

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1. Semm K. Endoscopic appendectomy. Endoscopy 1983;15:59–64.
2. Hansen JB, Smithers BM, Schache D, et al. Laparoscopic versus open appendectomy: prospective randomized trial. World J Surg 1996;20:17–20.
3. Aziret M, Palabıyık O, Karaman K, et al. Effectiveness of transversus abdominis plane block for laparoscopic appendectomy in non-perforated acute appendicitis. Laparosc Endosc Surg Sci 2018;25:133-9.
4. Aziret M, Çetinkünar S, Erdem H, et al. Comparison of open appendectomy and laparoscopic appendectomy with laparoscopic intracorporeal knotting and glove endobag techniques: A prospective observational study. Turk J Surg 2017;33:258-66.
5. Li X, Zhang J, Sang L, et al. Laparoscopic versus conventional appendectomy - a metaanalysis of randomized controlled trials. BMC Gastroenterol. 2010;10:129.
6. Cox TC, Huntington CR, Blair LJ, et al. Laparoscopic appendectomy and cholecystectomy versus open: a study in 1999 pregnant patients. Surg Endosc 2016;30:593-602.
7. Kulhan M, Kulhan NG, Uluğ P. Laparoscopic Surgery in Pregnant Women. Van Med J 2017;24:404-9.
8. Pearl JP, Price RR, Tonkin AE, et al. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 2017;31:3767-82.
9. Walsh CA, Tang T, Walsh SR. Laparoscopic versus open appendicectomy in pregnancy: a systematic review. Int J Surg 2008;6:339-44.
10. Wilasrusmee C, Sukrat B, McEvoy M, et al. Systematic review and metaanalysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy. Br J Surg 2012;99:1470-8.
11. Walker HG, Al Samaraee A, Mills SJ, et al. Laparoscopic appendicectomy in pregnancy: a systematic review of the published evidence. Int J Surg 2014;12:1235-41.
12. Stepp K, Falcone T. Laparoscopy in the second trimester of pregnancy. Obstet Gynecol Clin North Am 2004;31:485-96.
13. Panin AV, Dubrovsky AV, Petrov DY et al. The results of open and laparoscopic appendectomy in pregnant women with acute appendicitis. Hirurgiia (Mosk) 2016;4:21-5.
14. Levy T, Dicker D, Shalev J, et al. Laparoscopic unwinding of hyperstimulated ischaemic ovaries during the second trimester of pregnancy. Hum Reprod 1995;10:1478-80.
15. Frountzas M, Nikolaou C, Stergios K, et al. Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies. Ann R Coll Surg Engl 2019;101:235-48.
16. Lee SH, Lee JY, Choi YY, et al. Laparoscopic appendectomy versus open appendectomy for suspected appendicitis during pregnancy: a systematic review and updated meta-analysis. BMC Surg 2019;19:41.
17. Gök AFK, Soydaş Y, Bayraktar A, et al. Laparoscopic versus open appendectomy in pregnancy: A single center experience. Ulus Travma Acil Cerrahi Derg 2018;24:552-6.
18. McGory ML, Zingmond DS, Tillou A, et al. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 2007;205:534–40.
19. Won RP, Friedlander S, Lee SL. Management and outcomes of appendectomy during pregnancy. Am Surg 2017;83:103–7.