APPENDICITIS IN PREGNANCY: LAPAROSCOPY VERSUS OPEN SURGERY AND MATERNAL–FETAL OUTCOMES
Keywords:
Appendicitis; Pregnancy; Laparoscopy; Laparotomy; Fetal Outcomes; Magnetic Resonance Imaging; Prenatal UltrasonographyAbstract
DOI: https://doi.org/10.46296/gt.v8i16.0292
Abstract
Introduction: Acute appendicitis is the most common non-obstetric surgical emergency in pregnancy (~0.1%). Laparoscopy offers faster recovery and fewer wound complications, yet fetal safety versus open surgery remains debated. Methods: Narrative review (2015–2025) of PubMed/Scopus/UpToDate. We included meta-analyses and comparative studies (n≥50) exclusively in pregnant patients reporting at least one maternal and one fetal outcome; study quality appraised qualitatively with AMSTAR-2 and ROBINS-I. Results: Versus open appendectomy, laparoscopic appendectomy does not increase fetal loss or preterm birth. A meta-analysis (n≈4694) found comparable fetal risk (pooled OR≈1.16; p=0.58). Maternal outcomes favored laparoscopy with lower surgical-site infection (~60% reduction) and ~1-day shorter length of stay; neonatal outcomes (birthweight, Apgar, NICU admission) were similar between approaches. A stepwise imaging pathway (first-line ultrasound → non-contrast MRI when ultrasound is inconclusive) achieves high diagnostic accuracy (MRI sensitivity ~92%, specificity ~98%) and cuts negative appendectomies by ~50% without more perforations. Safe technical parameters include open/optical entry, 10–12 mmHg pneumoperitoneum, left lateral tilt, capnography, and VTE prophylaxis; pregnancy-compatible antibiotics include beta-lactams and clindamycin. Conclusions: Laparoscopy is the preferred approach in any trimester, delivering maternal benefits without a proven increase in adverse fetal events. We recommend rapid imaging-led diagnosis and timely surgery to prevent perforation (a key driver of fetal loss). Prospective registries are needed to refine trimester-specific effects, the selective role of non-operative management, and the impact of prophylactic tocolysis.
Keywords: Appendicitis; Pregnancy; Laparoscopy; Laparotomy; Fetal Outcomes; Magnetic Resonance Imaging; Prenatal Ultrasonography.
Downloads
References
Rountis A, Dimitroulis D, Nikiteas N. Apendicectomía laparoscópica vs abierta durante el embarazo: revisión sistemática. Hippokratia. 2022;26(1):1-6.
Lee SH, Lee JY, Choi YY, et al. Laparoscopic appendectomy versus open appendectomy for suspected appendicitis during pregnancy: a systematic review and meta-analysis. BMC Surg. 2019;19(1):41.
Zhang J, Xin Z, Li P, et al. Updated evaluation of laparoscopic vs. open appendectomy during pregnancy: a meta-analysis of obstetrical and perioperative outcomes. Front Surg. 2021;8:720351.
Duque GA, Lotfollahzadeh S. Appendicitis in Pregnancy. In: StatPearls Internet. Treasure Island, FL: StatPearls Publishing; 2023.
Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Update 2017.
ACOG Committee on Obstetric Practice. Committee Opinion No. 775: Nonobstetric Surgery During Pregnancy. Obstet Gynecol. 2019;133(2):e285-e286.
Augustin G, Majerovic M. Non-obstetric acute abdomen during pregnancy. Eur J Trauma Emerg Surg. 2015;41(4):379-388.
Sadot E, Telem DA, Arora M, et al. Laparoscopy: a safe approach to appendicitis during pregnancy. Surg Endosc. 2010;24(2):383-389.
Andersson B, Anderberg B, Kjølhede P, et al. Appendectomy during pregnancy: a population-based analysis of maternal outcome. Surg Endosc. 2015;29(6):1394-1399.
Pearson D, Larrazabal A, Telleria J, et al. Appendectomy during pregnancy: safety and outcomes. Am J Surg. 2017;213(4):763-767.
Ramos C, Rojas C, Nazer J, et al. Laparoscopic appendectomy in the third trimester: technique and literature review. Clin Surg. 2023;8:3623.
Barnes SL, Ultra SJ, Propst A, et al. Maternal and fetal outcomes after laparoscopic vs open appendectomy in pregnancy. J Am Coll Surg. 2004;199(3):378-383.
Affleck DG, Handrahan DL, Morgan MA, et al. The laparoscopic management of appendicitis and cholelithiasis during pregnancy. Am J Surg. 1999;178(6):523-529.
McGory ML, Zingmond DS, Tillou A, et al. Appendectomy vs. antibiotic management of acute appendicitis in pregnancy: a population-based analysis. J Am Coll Surg. 2007;205(4):534-540.
Rollins MD, Chan KJ, Price RR, et al. Efficacy of magnetic resonance imaging in pregnancy for suspected appendicitis. J Magn Reson Imaging. 2012;35(4):856-860.
Israel GM, Malvisi J, Mussi TC, et al. MRI vs. ultrasound for suspected appendicitis in pregnancy. J Magn Reson Imaging. 2008;28(2):428-433.
Cappell MS, Litkouhi B, Rabinerson D, et al. Management of abdominal pain and appendicitis in pregnancy. Dig Dis Sci. 2020;65(5):1256-1266.
Yilmaz HG, Akgun Y, Bac B, et al. Appendicitis in pregnancy: risk factors associated with perinatal outcomes. Acta Obstet Gynecol Scand. 2007;86(8):910-914.
Morozov V, Isakov A, Kenigsbuch-Sredniawa A, et al. Laparoscopic appendectomy in pregnancy: a systematic review of outcomes. JSLS. 2018;22(3):e2018.00042.
Tanos V, Guven S, Goeggeler-Karligkiotis A, et al. The role of tocolysis after surgical interventions during pregnancy: a systematic review. Facts Views Vis Obgyn. 2019;11(3):217-223.
Published
How to Cite
Issue
Section
Copyright (c) 2025 GESTAR Arbitrated Scientific Journal in Health Research. ISSN: 2737-6273.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
