Laparoscopic appendectomy in pregnant women: experience in Chittagong, Bangladesh.

Abstract

Surgery may be needed during pregnancy for nonobstetric reasons, most commonly appendicitis, and laparoscopy is considered as safe as the open method, for both mother and fetus. The aim of the present study was to emphasize the feasibility of laparoscopic appendectomy during pregnancy in a developing country, and also to report the first study of its kind from Bangladesh. From 7 October 2005 to 6 October 2010, 31 pregnant women were diagnosed with acute appendicitis. Diagnoses were based on clinical suspicion supported by ultrasonogram. Under general endotracheal anesthesia, laparoscopy was done in all 31 cases. One gynecologist was always present to monitor the conditions of the fetus preoperatively and postoperatively. Feeding was allowed 6 h after surgery, and the majority of the patients were discharged on the second postoperative day. Age, gestational period, operative time, hospital stay, maternal and fetal outcome, and complications were evaluated. Age ranged from 19 to 35 years and gestational period ranged from 6 to 31 weeks. Right lower quadrant pain was the presenting complaint in majority of cases. Average operative time was 34 ± 10.19 min, and there were no conversions to open surgery. There were no intraoperative or immediate postoperative hazards. Postoperative recovery was uneventful in all cases. Histopathology of 30 cases confirmed appendicitis. One patient, whose fetus was at 12 weeks gestation at the time of the appendectomy had a spontaneous abortion 1 month later. There were no adverse outcomes during the follow-up period. Laparoscopy is a safe and effective technique for the treatment of appendicitis during pregnancy and can be performed in a developing country.