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Traweek R, Phan V, Griesbach C, Hall C. General Surgery During Pregnancy and Gynecologic Emergencies. Surg Clin North Am 2023; 103:1217-1229. [PMID: 37838464 DOI: 10.1016/j.suc.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Nonobstetrical surgical emergencies can occur throughout pregnancy but are often difficult to diagnose due to the physiologic and anatomical changes that occur during pregnancy. Medical providers should have insight into these changes and be familiar with options for the diagnosis and management of common nonobstetrical surgical emergencies, such as appendicitis, cholecystitis, and small bowel obstruction. Surgeons should also be aware of obstetrical emergencies, such as ectopic pregnancy and severe vaginal bleeding, which may be life threatening to mother and the fetus. Intraoperatively, surgeons should be familiar with minimally invasive approaches for surgical diseases and special anesthetic considerations for pregnant patients.
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Affiliation(s)
- Raymond Traweek
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA
| | - Vivy Phan
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA
| | - Chad Griesbach
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA
| | - Chad Hall
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA.
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2
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Laparoscopic treatment for appendicitis during pregnancy: Retrospective cohort study. Ann Med Surg (Lond) 2021; 68:102668. [PMID: 34408866 PMCID: PMC8361228 DOI: 10.1016/j.amsu.2021.102668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background Acute appendicitis is the most frequent non-obstetric surgical emergency during pregnancy. The benefits of laparoscopy during pregnancy are well known, but complications can occur, and these can affect both the mother and/or the foetus.We present results of laparoscopic surgical treatment of acute appendicitis in pregnant women, analysing the occurrence of adverse postoperative, obstetric and foetal outcomes and reviewing literature. Materials and methods Retrospective observational study on pregnant women with a preoperative diagnosis of acute appendicitis. Results n = 63, mean age 28.4 years, average gestational age of 17.7 weeks (3-30 weeks). 6.4 % exploratory laparoscopies, 92 % laparoscopic appendectomies and one right colectomy were performed. Conversion rate was 3.2 %. When symptoms begun within 48 hours prior to surgery, a perforated appendicitis was found in 11 %; whereas when the time from symptom onset to surgery was greater than or equal to 48 hours, it was evident in 31 % of the cases (p 0.008). The only independent variable associated with the presence of postoperative complications was symptom duration prior to surgery greater than or equal to 48 hours (OR 4.8; 95 % CI 1.1-16.2; p 0.04). Seven minor and 2 mayor postoperative complications were observed. Patients with complications spent, on average, twice as many days hospitalized (p < 0.001); and had 8 times more risk of preterm delivery (p 0.03). Obstetric complications were more frequent in pregnant women operated during the first trimester. Foetal mortality was 1.6 %. Conclusion Surgical morbidity of acute appendicitis in pregnant women is linked to the delay in the diagnosis and treatment of the inflammatory condition. Laparoscopic appendectomy during pregnancy is not exempt from postoperative, obstetric and foetal complications. It is necessary to standardize the definitions of "complication" in order to collate reliably the outcomes presented in the literature.
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Pearl JP, Price RR, Tonkin AE, Richardson WS, Stefanidis D. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 2017; 31:3767-3782. [PMID: 28643072 DOI: 10.1007/s00464-017-5637-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/03/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Jonathan P Pearl
- University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA.
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4
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Segev L, Segev Y, Rayman S, Shapiro R, Nissan A, Sadot E. Appendectomy in Pregnancy: Appraisal of the Minimally Invasive Approach. J Laparoendosc Adv Surg Tech A 2016; 26:893-897. [PMID: 27668544 DOI: 10.1089/lap.2016.0280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The optimal surgical approach to acute appendicitis in pregnancy remains controversial. Our aim was to compare perioperative and obstetric outcomes associated with laparoscopic and open appendectomy in a large contemporary cohort of pregnant women. METHODS Retrospective review of all women who underwent appendectomy during pregnancy in a single hospital during 2000-2014. RESULTS Ninety-two patients met the study criteria. Fifty (54%) underwent laparoscopic appendectomy and 42 (46%) open appendectomy. The laparoscopy group had a lower median gestational age at surgery (16 weeks versus 24 weeks, P < .001), a shorter median hospital stay (5 days versus 3 days, P < .001), and a lower rate of postoperative complications (8% versus 24%, P = .04). There were no significant between-group differences in the rates of gestational age at delivery, Apgar scores, preterm delivery, and fetal loss. CONCLUSIONS Laparoscopic appendectomy during pregnancy is safe and associated with better surgical outcomes than open appendectomy, with no difference in obstetric outcomes.
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Affiliation(s)
- Lior Segev
- 1 Department of General and Oncological Surgery-Surgery C, Sheba Medical Center , Ramat Gan, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Yakir Segev
- 3 Department of Obstetrics and Gynecology, Carmel Medical Center , Haifa, Israel .,4 Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa, Israel
| | - Shlomi Rayman
- 1 Department of General and Oncological Surgery-Surgery C, Sheba Medical Center , Ramat Gan, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Ron Shapiro
- 1 Department of General and Oncological Surgery-Surgery C, Sheba Medical Center , Ramat Gan, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Aviram Nissan
- 1 Department of General and Oncological Surgery-Surgery C, Sheba Medical Center , Ramat Gan, Israel .,2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Eran Sadot
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel .,5 Department of Surgery B, Rabin Medical Center , Petah Tikva, Israel
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Winter NN, Guest GD, Bozin M, Thomson BN, Mann GB, Tan SBM, Clark DA, Daruwalla J, Muralidharan V, Najan N, Pitcher ME, Vilhelm K, Cox MR, Lane SE, Watters DA. Laparoscopic or open appendicectomy for suspected appendicitis in pregnancy and evaluation of foetal outcome in Australia. ANZ J Surg 2016; 87:334-338. [PMID: 27598241 DOI: 10.1111/ans.13750] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 07/26/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Nicole N. Winter
- Department of Surgery; Barwon Health; Geelong Victoria Australia
- Department of Specialist General Surgery; The Royal Melbourne Hospital; Parkville Victoria Australia
| | - Glenn D. Guest
- Department of Surgery; Barwon Health; Geelong Victoria Australia
| | - Michael Bozin
- Department of Specialist General Surgery; The Royal Melbourne Hospital; Parkville Victoria Australia
| | - Benjamin N. Thomson
- Department of Specialist General Surgery; The Royal Melbourne Hospital; Parkville Victoria Australia
| | - G. Bruce Mann
- Breast Service, The Royal Women's Hospital; The University of Melbourne; Parkville Victoria Australia
| | - Stephanie B. M. Tan
- Department of Surgery; Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - David A. Clark
- Department of Surgery; Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Jurstine Daruwalla
- Department of Surgery, Austin Health; The University of Melbourne; Heidelberg Victoria Australia
| | | | - Neeha Najan
- Department of Surgery; Western Health; Footscray Victoria Australia
| | - Meron E. Pitcher
- Department of Surgery; Western Health; Footscray Victoria Australia
| | - Karina Vilhelm
- Department of Surgery; Nepean Hospital; Kingswood New South Wales Australia
| | - Michael R. Cox
- Department of Surgery; University of Sydney Clinical School, Nepean Hospital; Kingswood New South Wales Australia
| | - Steven E. Lane
- Biostatistics Unit; Barwon Health; Geelong Victoria Australia
- School of Medicine; Deakin University; Geelong Victoria Australia
| | - David A. Watters
- Department of Surgery, Barwon Health; Deakin University; Geelong Victoria Australia
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Iftikhar H, Idu S, Omer A. Teratodermoid mimicking cholecystitis. Clin Case Rep 2016; 4:494-8. [PMID: 27190615 PMCID: PMC4856244 DOI: 10.1002/ccr3.554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 06/01/2015] [Accepted: 08/13/2015] [Indexed: 11/16/2022] Open
Abstract
An acute abdomen assessment in pregnancy is complicated. Pain can have obstetric and nonobstetric causes. Cholecystitis is a common cause of pain in pregnancy with significant morbidity if not managed promptly. We report a case of a ruptured, torted, right ovarian teratodermoid erroneously diagnosed as cholecystitis in pregnancy.
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Affiliation(s)
- Hina Iftikhar
- Surgery Ipswich Hospital NHS trust Ipswich Suffolk UK
| | - Shareen Idu
- Surgery Ipswich Hospital NHS trust Ipswich Suffolk UK
| | - Abdel Omer
- Surgery Ipswich Hospital NHS trust Ipswich Suffolk UK
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7
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George PE, Shwaartz C, Divino CM. Laparoscopic surgery in pregnancy. World J Obstet Gynecol 2016; 5:175-181. [DOI: 10.5317/wjog.v5.i2.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/18/2016] [Indexed: 02/05/2023] Open
Abstract
Each year, roughly 2% of pregnant women will undergo non-obstetrical abdominal surgery. Appendicitis, symptomatic cholelithiasis and adnexal masses are some of the common diagnoses encountered. Pregnancy poses challenges in the diagnosis and surgical management of these conditions for several reasons. Since the 1990’s, laparoscopic surgery has gained popularity and in the past few years has become the standard of care for pregnant women with surgical pathologies. The advantages of laparoscopic surgery include shorter hospital stay, lower rates of wound infection, and decreased time to bowel function. This brief review discusses key points in laparoscopic surgery during pregnancy and highlights studies comparing laparoscopic and open approaches in common surgical conditions during pregnancy.
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Laparoscopic cholecystectomy during pregnancy: A systematic review of 590 patients. Int J Surg 2016; 27:165-175. [DOI: 10.1016/j.ijsu.2016.01.070] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/19/2016] [Indexed: 02/06/2023]
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Juhasz-Böss I, Solomayer E, Strik M, Raspé C. Abdominal surgery in pregnancy--an interdisciplinary challenge. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:465-72. [PMID: 25138726 DOI: 10.3238/arztebl.2014.0465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 09/29/2013] [Accepted: 04/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abdominal operations are performed during ca. 2% of all pregnancies. They represent an unusual situation not only for the patient, but also for the involved surgeons and anesthesiologists. Appendectomy, followed by cholecystectomy are the two most common types of operation performed during pregnancy. Special questions arise with regard to the peri- and intraoperative management and the optimal surgical approach. METHOD This review is based on pertinent articles retrieved by a selective search in the PubMed database. RESULTS The question of laparoscopy versus laparotomy during pregnancy has been addressed to date only in case series and a few meta-analyses. Two meta-analyses have shown a significantly higher rate of miscarriage after laparoscopic, compared to open, appendectomy (relative risk [RR] 1.91, 95% confidence interval [CI] 1.31-2.77). The risk of preterm birth is also somewhat higher after laparoscopic appendectomy according to one meta-analysis on this subject (RR 1.44, 95% CI 0.78-1.76), but significantly lower according to another meta-analysis (2.1% vs. 8.1%, p<0.0001). For cholecystectomy, laparoscopy was associated with a lower miscarriage rate than laparotomy (1 in 89 cases, versus 2 in 69 cases), but with a somewhat higher preterm birth rate (6 in 89 cases, versus 2 in 69 cases). Delay or non-performance of surgery in a patient with appendicitis or cholecystitis can lead to additional hospitalizations, a higher miscarriage rate, premature rupture of the membranes, and preterm birth. CONCLUSION Laparoscopy in experienced hands is safe even during pregnancy, with the recognized advantages of minimally invasive surgery, yet it carries a higher miscarriage rate than laparotomy, with a comparable preterm birth rate. Before surgery, patients should be thoroughly informed about the operation they are about to undergo and the advantages and disadvantages of the available surgical approaches.
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Affiliation(s)
- Ingolf Juhasz-Böss
- Department of Gynecology and Obstetrics, Saarland University Medical Center, Homburg/Saar
| | - Erich Solomayer
- Department of Gynecology and Obstetrics, Saarland University Medical Center, Homburg/Saar
| | - Martin Strik
- Department of Surgery and Surgical Oncology, HELIOS-Klinikum Berlin-Buch
| | - Christoph Raspé
- Department of Anaesthesiology and Surgical Intensive Care, University Hospital of Halle (Saale)
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Stewart MK, Terhune KP. Management of pregnant patients undergoing general surgical procedures. Surg Clin North Am 2015; 95:429-42. [PMID: 25814116 DOI: 10.1016/j.suc.2014.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pregnant patients have a 0.2% to 0.75% chance of developing a medical condition that requires a general surgical intervention during pregnancy. To safely and appropriately care for patients, surgeons must be cognizant of the maternal physiologic changes in pregnancy as well as of the unique risk to both mothers and fetuses of diagnostic modalities, anesthetic care, operative intervention, and postoperative management. Surgeons can be assured that, if these risks are understood and considered, operating during pregnancy, even in the abdomen, can be safely undertaken.
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Affiliation(s)
- Melissa K Stewart
- Department of Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN 37232, USA
| | - Kyla P Terhune
- Department of Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN 37232, USA.
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11
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Brown J, Boruta D. Laparoscopic Management of Pelvic Masses in Pregnancy. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Altieri MS, Telem DA, Kim P, Gracia G, Pryor AD. Case review and consideration for imaging and work evaluation of the pregnant bariatric patient. Surg Obes Relat Dis 2014; 11:667-71. [PMID: 25620437 DOI: 10.1016/j.soard.2014.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/24/2014] [Accepted: 09/24/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is an increasing trend toward morbid obesity in women of childbearing age and a subsequent increase in number of weight reduction surgeries in these individuals. As a result, special attention needs to be paid to potential postsurgical complications during pregnancy, particularly after Roux-en-Y gastric bypass (RYGB). We are presenting our small case series and our suggestions for management for the pregnant bariatric patient. The aim of this study is to review our institutional experience and present our algorithm to approach pregnant women presenting with abdominal pain and/or emesis after RYGB. METHODS After Institutional Review Board approval, a retrospective chart review was performed at a single center institution between 2010 and 2013. Data regarding clinical presentation, physical exam findings, laboratory values, radiographic studies, intraoperative findings, and clinical outcomes of both mother and fetus were collected and reviewed for pregnant patients with history of RYGB and abdominal distress. RESULTS Five patients were identified. Patient age ranged from 22-34 years (mean 28.4). Gestational age ranged from 9-31 months (mean 19.2). Average body mass index at presentation was 30.3 kg/m(2). Of the 5 patients, 4 presented with abdominal pain and one with intractable emesis. Four patients were taken to the operating room. One was successfully discharged. Two of the patients had an obstruction from adhesions, and the other 2 were found to have internal hernia. There was no mortality for either fetus or mother. One patient required premature delivery at 28 weeks. CONCLUSIONS Pregnant women with history of RYGB who present with abdominal pain should be evaluated urgently for internal hernia or obstruction. A systematic approach is needed to ensure prompt diagnosis.
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Affiliation(s)
- Maria S Altieri
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York.
| | - Dana A Telem
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York
| | - Pamela Kim
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York
| | - Gerald Gracia
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York
| | - Aurora D Pryor
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York
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Larsson A. Clinical significance of elevated intraabdominal pressure during common conditions and procedures. Acta Clin Belg 2014; 62 Suppl 1:74-7. [PMID: 24881703 DOI: 10.1179/acb.2007.62.s1.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Pregnancy, obesity, peritoneal dialysis, pneumoperitoneum, prone position and application of positive end-expiratory pressure are associated with elevated intraabdominal pressure (IAP). OBJECTIVE To review the relation between these conditions and procedures, and intraabdominal hypertension (IAH) or abdominal compartment syndrome (ACS). METHODS Search of PubMed and Google Scholar and review of article bibliographies. RESULTS AND CONCLUSION Only obesity, peritoneal dialysis, and pneumoperitoneum are associated with symptoms related to IAH and these symptoms are reversible.
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Nicoll LM, Nezhat C. Laparoscopic management of pelvic pathology during pregnancy. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.4.1.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kastenberg ZJ, Hurley MP, Luan A, Vasu-Devan V, Spain DA, Owens DK, Goldhaber-Fiebert JD. Cost-effectiveness of preoperative imaging for appendicitis after indeterminate ultrasonography in the second or third trimester of pregnancy. Obstet Gynecol 2013; 122:821-829. [PMID: 24084540 PMCID: PMC3995975 DOI: 10.1097/aog.0b013e3182a4a085] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the cost-effectiveness of diagnostic laparoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) after indeterminate ultrasonography in pregnant women with suspected appendicitis. METHODS A decision-analytic model was developed to simulate appendicitis during pregnancy taking into consideration the health outcomes for both the pregnant women and developing fetuses. Strategies included diagnostic laparoscopy, CT, and MRI. Outcomes included positive appendectomy, negative appendectomy, maternal perioperative complications, preterm delivery, fetal loss, childhood cancer, lifetime costs, discounted life expectancy, and incremental cost-effectiveness ratios. RESULTS Magnetic resonance imaging is the most cost-effective strategy, costing $6,767 per quality-adjusted life-year gained relative to CT, well below the generally accepted $50,000 per quality-adjusted life-year threshold. In a setting where MRI is unavailable, CT is cost-effective even when considering the increased risk of radiation-associated childhood cancer ($560 per quality-adjusted life-year gained relative to diagnostic laparoscopy). Unless the negative appendectomy rate is less than 1%, imaging of any type is more cost-effective than proceeding directly to diagnostic laparoscopy. CONCLUSIONS Depending on imaging costs and resource availability, both CT and MRI are potentially cost-effective. The risk of radiation-associated childhood cancer from CT has little effect on population-level outcomes or cost-effectiveness but is a concern for individual patients. For pregnant women with suspected appendicitis, an extremely high level of clinical diagnostic certainty must be reached before proceeding to operation without preoperative imaging.
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Affiliation(s)
- Zachary J Kastenberg
- Center for Health Policy and Center for Primary Care and Outcomes Research, Department of Medicine, and the Department of Surgery, Stanford University, Stanford, and the Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Wilasrusmee C, Sukrat B, McEvoy M, Attia J, Thakkinstian A. Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy. Br J Surg 2012; 99:1470-8. [PMID: 23001791 PMCID: PMC3494303 DOI: 10.1002/bjs.8889] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic appendicectomy has gained wide acceptance as an alternative to open appendicectomy during pregnancy. However, data regarding the safety and optimal surgical approach to appendicitis in pregnancy are still controversial. METHODS This was a systematic review and meta-analysis of studies comparing laparoscopic and open appendicectomy in pregnancy identified using PubMed and Scopus search engines from January 1990 to July 2011. Two reviewers independently extracted data on fetal loss, preterm delivery, wound infection, duration of operation, hospital stay, Apgar score and birth weight between laparoscopic and open appendicectomy groups. RESULTS Eleven studies with a total of 3415 women (599 in laparoscopic and 2816 in open group) were included in the analysis. Fetal loss was statistically significantly worse in those who underwent laparoscopy compared with open appendicectomy; the pooled relative risk (RR) was 1·91 (95 per cent confidence interval (c.i.) 1·31 to 2·77) without heterogeneity. The pooled RR for preterm labour was 1·44 (0·68 to 3·06), but this risk was not statistically significant. The mean difference in length of hospital stay was - 0·49 (-1·76 to - 0·78) days, but this was not clinically significant. No significant difference was found for wound infection, birth weight, duration of operation or Apgar score. CONCLUSION The available low-grade evidence suggests that laparoscopic appendicectomy in pregnant women might be associated with a greater risk of fetal loss.
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Affiliation(s)
- C Wilasrusmee
- Department of Surgery, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Malbrain MLNG, De Laet IE. Intra-abdominal hypertension: evolving concepts. Crit Care Nurs Clin North Am 2012; 24:275-309. [PMID: 22548864 DOI: 10.1016/j.ccell.2012.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Manu L N G Malbrain
- Intensive Care Unit, ZiekenhuisNetwerk Antwerpen, Campus Stuivenberg, Antwerpen, Belgium.
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18
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Donkervoort SC, Boerma D. Suspicion of acute appendicitis in the third trimester of pregnancy: pros and cons of a laparoscopic procedure. JSLS 2011; 15:379-83. [PMID: 21985728 PMCID: PMC3183570 DOI: 10.4293/108680811x13125733356837] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
This review suggests that diagnostic laparoscopy during the third trimester of pregnancy is a logical strategy to minimize maternal and fetal risk when acute appendicitis is suspected. The presentation of acute appendicitis during pregnancy may cause diagnostic and therapeutic difficulty. Delay in diagnosis may lead to increased maternal and fetal risk. Therefore, an aggressive surgical approach is mandatory, even though this may result in an increased number of appendectomies for normal appendices. Diagnostic laparoscopy, followed by laparoscopic appendectomy in case of inflammation, seems a logical strategy. We present the case of a 36-week pregnant woman who presented with suspicion of acute appendicitis. The pro and cons of a laparoscopic approach in the third trimester of pregnancy are discussed as is its safety by reviewing the literature.
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Affiliation(s)
- S C Donkervoort
- Onze Lieve Vrouwe Gasthuis, Department of Surgery, Amsterdam, The Netherlands
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Pearl J, Price R, Richardson W, Fanelli R. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 2011; 25:3479-3492. [PMID: 21938570 DOI: 10.1007/s00464-011-1927-3] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/24/2011] [Indexed: 12/11/2022]
Affiliation(s)
- Jonathan Pearl
- Department of General Surgery, Uniformed Services University of the Health Sciences, National Naval Medical Center, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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de Bakker JK, Dijksman LM, Donkervoort SC. Safety and outcome of general surgical open and laparoscopic procedures during pregnancy. Surg Endosc 2010; 25:1574-8. [PMID: 21052721 DOI: 10.1007/s00464-010-1441-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 10/07/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgical procedures during pregnancy carry the risk of adverse fetal outcome. We analyzed outcomes of open and laparoscopic approaches in patients treated for symptomatic cholelithiasis and suspected appendicitis. We reviewed the literature for evidence on the safety of both procedures. METHODS We retrospectively reviewed the data of all patients who underwent surgery for symptomatic cholelithiasis and suspicion of appendicitis during pregnancy between January 2004 and March 2009. Fetal loss, preterm delivery, maternal outcome, and surgical complications were assessed. RESULTS Twenty patients were operated on during pregnancy: 5 of 652 (0.8%) patients with symptomatic cholelithiasis and 15 (4.5%) of 331 for suspected appendicitis. All cholecystectomies were performed by laparoscopic procedure; no premature deliveries or fetal death occurred. In patients with suspicion of appendicitis, three appendices sana were diagnosed laparoscopically, and nine laparoscopic appendectomies and three open appendectomies were performed. The outcome was two preterm deliveries and one fetal death. CONCLUSION Reviewing our results and the available literature, we believe that the outcome of surgery during pregnancy is not dictated by the type of procedure but by the type of disease. The gain for fetal outcome in the future most likely lies in the diagnostic pathway rather than the type of surgery.
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Affiliation(s)
- J K de Bakker
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Postbus 95500, 1090, HM, Amsterdam, The Netherlands.
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Abstract
This article focuses primarily on the recent literature on abdominal compartment syndrome (ACS) and the definitions and recommendations published by the World Society for the Abdominal Compartment Syndrome. The definitions regarding increased intra-abdominal pressure (IAP) are listed and are followed by an overview of the different mechanisms of organ dysfunction associated with intra-abdominal hypertension (IAH). Measurement techniques for IAP are discussed, as are recommendations for organ function support and options for treatment in patients who have IAH. ACS was first described in surgical patients who had abdominal trauma, bleeding, or infection; but recently, ACS has been described in patients who have other pathologies. This article intends to provide critical care physicians with a clear insight into the current state of knowledge regarding IAH and ACS.
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Affiliation(s)
- Manu L N G Malbrain
- Intensive Care Unit, ZiekenhuisNetwerk Antwerpen, Campus Stuivenberg, Antwerpen, Belgium.
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22
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Laparoscopic ventral hernia repair during pregnancy. Hernia 2009; 13:559-63. [PMID: 19280274 DOI: 10.1007/s10029-009-0476-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 01/09/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic ventral hernia repair in comparison to open herniorrhaphy results in reduced length of stay, less post-operative pain, earlier return to work, and reduced complications for the repair of complex ventral hernias. The laparoscopic approach has been the standard of care for complex or large ventral hernias for non-pregnant patients over the past decade. Despite evidence that demonstrates that laparoscopy is safe during pregnancy, there is currently no consensus regarding the indications, contraindications, patient selection and post-operative care of pregnant patients evaluated for laparoscopic ventral herniorrhaphy. METHODS The medical records of our pregnant patient who underwent laparoscopic ventral herniorrhaphy were reviewed for demographics, operative indications, surgical technique, perioperative complications, recurrence, and outcome of the pregnancy. A Medline search using the terms: laparoscopy, surgery, and pregnancy was performed to review the literature from 1997 to 2007. RESULTS This case report represents the first published description of a safe and successful laparoscopic approach to the repair of a complex ventral hernia in a woman at 21 weeks gestation. The discussion reviews the current literature regarding the safety of laparoscopy in pregnant women and highlights techniques to reduce perioperative morbidity and risk to the fetus. CONCLUSIONS Laparoscopic ventral hernia repair can be safe during pregnancy with appropriate fetal monitoring and consideration of physiologic changes that occur during parturition. Elective procedures should be delayed until after delivery and all semi-elective surgeries until organogenesis is completed during the second trimester.
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Kirshtein B, Perry ZH, Avinoach E, Mizrahi S, Lantsberg L. Safety of laparoscopic appendectomy during pregnancy. World J Surg 2009; 33:475-480. [PMID: 19137365 DOI: 10.1007/s00268-008-9890-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Use of laparoscopic appendectomy (LA) remains controversial during pregnancy because data regarding procedure safety are limited. The outcome of LA in pregnant women was evaluated and compared to results of open surgery. METHODS Between January 1997 and December 2007, 42 pregnant women (mean age 24 years [range: 19-40 years]; range of gestation: 5-25 weeks) underwent appendectomy for suspected acute appendicitis: 23 laparoscopic (LA) and 19 open appendectomies (OA). Retrospective review of medical charts included preoperative information, surgery results, and outcome of the pregnancy. RESULTS There was no difference between groups in surgery delay following arrival at the hospital. All procedures, except one case of Meckel's diverticulitis, were completed laparoscopically without need for conversion. Acute appendicitis was found in 19 cases and Meckel's diverticulitis in one case during LA (87%) and in 18 cases (95%) during OA. Complicated appendicitis was found in 7 (30%) pregnant women in the LA group and 1 (5%) in the OA group. Five women with normal preoperative abdominal ultrasonography had acute appendicitis (2 in the OA group and 3 in the LA group). The laparoscopic procedure was performed more often by senior surgeons (70% of cases), and OA was more commonly done by residents (47% of cases). There were no intraoperative or postoperative complications recorded. The length of postoperative hospital stay was slightly prolonged after LA-2.4 days versus 1.4 day after OA. There was one fetal loss in each group, 1 and 2 months after the operation. CONCLUSIONS Laparoscopic appendectomy is safe and effective during pregnancy and is associated with good maternal and fetal outcome.
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Affiliation(s)
- Boris Kirshtein
- Department of Surgery "A", Soroka University Medical Center, POB 151, Beer-Sheva 84101, Israel.
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Abstract
The incidence of gallstones during pregnancy is estimated to be between 3% and 12%. About one-third of pregnant patients with cholelithiasis become symptomatic and may require surgical intervention. Choledocholithiasis during pregnancy although infrequent usually requires therapeutic intervention. Abdominal ultrasonography is insensitive for the detection of common bile duct stones. Magnetic resonance imaging is not being associated with known adverse effects and seems to be an excellent diagnostic modality in this context. Paramagnetic contrast agents have been associated with increased spontaneous abortion rates and other abnormalities in animals and should only be used when absolutely necessary. Endoscopic ultrasonography is highly accurate for the detection of common bile duct stones and may be useful before consideration of endoscopic retrograde cholangiopancreatography (ERCP) in select patients. The second trimester seems to be the safest time to perform surgery, as organogenesis is complete and the incidence of spontaneous abortion lower. ERCP followed by sphincterotomy and stone extraction is very effective and can be performed safely during all trimesters of pregnancy with a premature delivery rate less than 5%. All efforts to minimize radiation exposure should be undertaken. These include lead shielding and avoiding hard copy radiographs. When possible, category B (such as meperidine) or C drugs only should be used for sedation during pregnancy. Therapeutic ERCP is now the standard of care for treating choledocholithiasis during pregnancy. Endoscopic sphincterotomy for symptomatic patients with normal cholangiograms is controversial. Consideration of ERCP demands a judicious approach, paying careful attention to risks and benefits of intervention.
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Jackson H, Granger S, Price R, Rollins M, Earle D, Richardson W, Fanelli R. Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review. Surg Endosc 2008; 22:1917-1927. [PMID: 18553201 DOI: 10.1007/s00464-008-9989-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Accepted: 05/05/2008] [Indexed: 12/16/2022]
Abstract
Treatment of surgical disease in the gravid patient requires a unique and careful approach where safety of the mother and fetus are both considered. Approaches to diagnosis and therapy of surgical disease in the gravid patient are increasingly clarified and defined in the literature. Laparoscopy, once described as contraindicated in pregnancy, has been steadily accepted and applied as data supporting its safety and use have accumulated. An extensive review of the literature was performed to define the use of laparoscopy in pregnancy. Diagnoses for independent surgical diseases as well as imaging modalities and techniques during pregnancy are reviewed. Preoperative, intraoperative, and postoperative management of the pregnant patient are described and evaluated with focus on use of laparoscopy. Literature supporting safety and efficacy of laparoscopy in cholecystectomy, appendectomy, solid organ resection, and oophorectomy in the gravid patient is outlined. Based on level of evidence, this review includes recommendations specific to surgical approach, trimester of pregnancy, patient positioning, port placement, insufflation pressure, monitoring, venous thromboembolic prophylaxis, obstetric consultation, and use of tocolytics in the pregnant patient.
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Affiliation(s)
- Heidi Jackson
- Department of Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
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Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 2008; 22:849-61. [DOI: 10.1007/s00464-008-9758-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Accepted: 01/08/2008] [Indexed: 01/06/2023]
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Walsh CA, Tang T, Walsh SR. Laparoscopic versus open appendicectomy in pregnancy: a systematic review. Int J Surg 2008; 6:339-44. [PMID: 18342590 DOI: 10.1016/j.ijsu.2008.01.006] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 12/27/2007] [Accepted: 01/22/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acute appendicitis is the most common non-obstetric indication for surgical intervention in pregnant women. The benefits of a laparoscopic over an open approach to appendicectomy are well established in the non-pregnant population. Data on the optimal surgical approach to acute appendicitis in pregnant women are conflicting. METHODS A systematic review of reported cases of laparoscopic appendicectomy (LA) in pregnancy over the period 1990 to 2007. Twenty-eight articles documenting 637 cases of LA in pregnancy were included. Data on pregnancy outcome, patient characteristics, operative technique and peri-operative complications were analysed. RESULTS The rate of fetal loss following LA in pregnancy approaches 6% and is significantly higher than that following open appendicectomy. Fetal loss was highest in cases of complicated appendicitis. Incidence of preterm delivery appears lower in the LA group although this complication is likely to be under-reported in a significant proportion of cases. Trimester at the time of LA does not appear to influence complication rates. The negative appendicectomy rate in this series was 27%, which is higher than in the non-pregnant population. Complication rates following LA with negative appendicitis are as high as with simple appendicitis. Rates of entry-related complications were 2.8% in the Veress needle group and 0% in the Hasson open entry group. The overall rate of conversion to laparotomy was 1%. No difference was found in the preterm delivery rate between women who received prophylactic tocolysis and those who were not tocolysed. CONCLUSIONS Laparoscopic appendicectomy in pregnancy is associated with a low rate of intra-operative complications in all trimesters. However, LA in pregnancy is associated with a significantly higher rate of fetal loss compared to open appendicectomy. Rates of preterm delivery appear similar or slightly better following a laparoscopic approach. Open appendicectomy would appear to be the safer option for pregnant women for whom surgical intervention is indicated.
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Affiliation(s)
- Colin A Walsh
- Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 2QQ, UK, UK
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Lu EJ, Curet MJ. Surgical Care of the Pregnant Patient. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Laparoscopic Surgery for Symptomatic Cholelithiasis During Pregnancy. Surg Laparosc Endosc Percutan Tech 2007; 17:482-6. [DOI: 10.1097/sle.0b013e3181379e3d] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moreno-Sanz C, Pascual-Pedreño A, Picazo-Yeste JS, Seoane-Gonzalez JB. Laparoscopic appendectomy during pregnancy: between personal experiences and scientific evidence. J Am Coll Surg 2007; 205:37-42. [PMID: 17617330 DOI: 10.1016/j.jamcollsurg.2007.01.068] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 01/27/2007] [Accepted: 01/31/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although laparoscopic appendectomy is a safe and effective procedure for management of acute appendicitis, data about the feasibility and safety during pregnancy are limited. We aimed to study our experience in this field and to review the scientific evidence available. STUDY DESIGN All patients undergoing laparoscopic appendectomy during pregnancy, from January 2003 to December 2005, were included. Medical files were reviewed retrospectively. In addition, 133 cases from the literature were reviewed. General features of the cases, surgical technique details, and outcomes were analyzed. RESULTS All laparoscopic procedures were completed without conversion to open operation. No substantial hemodynamic or gasometric changes were detected during the procedures. Tocolytic medication was not administered in any patient. All patients were discharged from hospital within the first 48 postoperative hours, and no complications were recorded during this period or in the followup. All newborns had an adequate weight for gestational age, satisfactory parameters of well-being at birth, and an uneventful development after 1-year followup. CONCLUSIONS Laparoscopic appendectomy during pregnancy is as effective and safe as the conventional approach and has all the benefits of minimally invasive operation, provided that specific recommendations for these types of patients are strictly followed. It must be mentioned that there is only limited scientific evidence to support this statement.
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Affiliation(s)
- Carlos Moreno-Sanz
- Department of General Surgery, La Mancha-Centro General Hospital, Alcazar de San Juan, Ciudad Real, Spain.
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Jelin EB, Smink DS, Vernon AH, Brooks DC. Management of biliary tract disease during pregnancy: a decision analysis. Surg Endosc 2007; 22:54-60. [PMID: 17713817 DOI: 10.1007/s00464-007-9220-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2006] [Revised: 08/27/2006] [Accepted: 10/09/2006] [Indexed: 12/14/2022]
Abstract
BACKGROUND The appropriate management of biliary tract disease during pregnancy is uncertain. Although laparoscopic cholecystectomy can be performed safely during pregnancy, the timing and indications for this surgical intervention have not been firmly established. METHODS We constructed a Markov decision analytic model that incorporates maternal well-being and fetal outcome into a choice between nonoperative management (NM) and laparoscopic cholecystectomy (LC) for pregnant women with biliary tract disease (BTD). Our model cycles through weeks of pregnancy for a cohort of 200 gravid women presenting with biliary tract disease in both the first and second trimesters. Weekly state probabilities and utilities for fetal outcome were derived from the literature, while weekly utilities for disease and operative states were estimated in consultation with obstetricians. We cycled the model from 6 to 42 weeks and from 19 to 42 weeks to simulate first and second trimester presentations. Outcomes are expressed in quality pregnancy weeks (QPWs). One QPW is the utility of a normal healthy week of pregnancy. RESULTS A comprehensive search of the literature yielded a fetal death rate following LC for biliary tract disease of 2.2% and following NM of 7%. Relapse rates were found to be trimester dependent and estimated to be 55%, 55%, and 40% in the first, second, and third trimester, respectively. For a hypothetical cohort of 100 women presenting with biliary tract disease in their first trimester, LC generated 12,800 QPWs compared with 12,400 QPWs for NM, an average gain of 4 QPWs per woman. For the cohort of women entering the model in the second trimester, 11,600 QPWs were accrued by the LC group and 11,400 QPWs by the NM group, an average gain of 2 QPWs per woman. These findings were sensitive only to changes in fetal death rates under the two treatment arms. CONCLUSIONS Laparoscopic cholecystectomy is superior to nonoperative management for pregnant women presenting in the first or second trimester with biliary tract disease.
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Affiliation(s)
- Eric B Jelin
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
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Bashirov E, Cetiner S, Emre M, Seydaliyeva T, Alic V, Daglioglu K, Ozalevli M, San M, Topcuoglu MS. A randomized controlled study evaluating the effects of the temperature of insufflated CO2 on core body temperature and blood gases (an experimental study). Surg Endosc 2007; 21:1820-5. [PMID: 17516120 DOI: 10.1007/s00464-007-9295-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 12/24/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Heated carbon dioxide (CO2) was used for pneumoperitoneum (Pp) to prevent hypothermia. This study aimed to investigate the relationship between the temperature of the insufflated CO2 and blood gases together with the core body temperature (CBT). METHODS A prospective controlled study was performed with 24 pigs weighing approximately 20 kg randomized into four groups of 6 pigs each. A pneumoperitoneum at 12 mmHg of pressure was applied for 60 min with the pig under general anesthesia. The CO2)temperature was 22 degrees C in group 1, 37 degrees C in group 2, and 7 degrees C in group 3. In the "sham" group, pneumoperitoneum was not applied. Arterial blood pH and partial pressure of CO2 (PaCO2) were analyzed before insufflation, every 15 min during the pneumoperitoneum, and 15 min after the desufflation. The CBT was recorded before the insufflation, every 20 min during pneumoperitoneum, and 20 min after the desufflation. Blood gas analyses and CBT records for the "sham" group were performed at the same intervals. RESULTS Arterial blood pH gradually decreased during pneumoperitoneum. At the 60th minute of pneumoperitoneum, a minimum decrease in arterial blood pH (0.04; p = 0.027) and a minimum increase in PaCO2 (3.67; p = 0.027) were recorded in group 3, whereas a maximum decrease in arterial blood pH (0.18; p = 0.027) and a maximum increase in PaCO2 (17.17; p = 0.027) were recorded in group 2. There was a significant negative correlation between PaCO2 and arterial blood pH in all the groups (r = -0.993; p < 0.01). The mean values of CBT decreases were statistically significant in all the groups: group 1 (p = 0.023), group 2 (p = 0.026), group 3 (p = 0.026), and "sham" group (p = 0.024). CONCLUSIONS The changes in PaCO2 were directly proportional and the changes in pH contrarily proportional to the temperature of the insufflated CO2. Significant differences in CBT decreases were found between the groups receiving heated gas and room temperature gas and the groups receiving heated gas and gas below room temperature.
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Affiliation(s)
- E Bashirov
- Department of General Surgery, Mustafa Kemal University School of Medicine, Bagriyanik mah., 31100, Antakya, Hatay, Turkey.
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Upadhyay A, Stanten S, Kazantsev G, Horoupian R, Stanten A. Laparoscopic management of a nonobstetric emergency in the third trimester of pregnancy. Surg Endosc 2007; 21:1344-8. [PMID: 17285387 DOI: 10.1007/s00464-006-9104-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Accepted: 10/16/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic management of nonobstetric acute abdominal pain during pregnancy remains controversial. A gestational age of 26 to 28 weeks has been considered the upper limit for laparoscopy by some authors. A case series of nonobstetric surgery in advanced pregnancy is reported. METHODS Third-trimester patients who underwent surgery between 1997 and 2006 were reviewed. RESULTS Laparoscopic surgery was performed for nonobstetric emergencies during the third trimester for 11 patients. Four patients underwent open surgery. The laparoscopic surgery group included five cholecystectomies, four appendectomies, and two adenexal surgeries. The laparoscopic surgery procedure was successfully completed for 10 patients. Of these 10 patients, 9 had no complications and went on to deliver a healthy term infant. One patient went into preterm labor after a laparoscopic appendectomy for perforated acute appendicitis with purulent peritonitis and delivered a viable infant at 34 weeks. Another patient at 29 weeks of gestation underwent a diagnostic laparoscopy for abdominal pain. Adenexal torsion of a large multicystic ovarian mass led to a laparotomy (obstetrician preference) and right salpingo-oophrectomy. Her postoperative course was complicated by an episode of sudden syncope, hypotension, and fetal distress on postoperative day 3. An emergent laparotomy showed hemoperitoneum attributable to bleeding from the ovarian pedicle. A cesarean section delivery of a preterm infant requiring neonatal resuscitation was performed. The open surgery group included four patients. Two of the patients underwent appendectomies at 35 and 33 weeks, respectively, followed by a term delivery. The remaining two patients underwent emergent colectomies with a cesarean section delivery at 31 and 38 weeks, respectively. CONCLUSIONS This study demonstrated that laparoscopic surgery in the third trimester of pregnancy is feasible and can be performed safely with an acceptable risk to the fetus and the mother. Access to the pregnant abdomen is easily obtained. Space generally is not a problem, and there is minimal uterine manipulation.
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Affiliation(s)
- A Upadhyay
- Department of Surgery, Alta Bates Summit Medical Center, 365 Hawthrone Avenue #101, Oakland, California 94609, USA.
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Moreno-Sanz C, Pascual-Pedreño A, Picazo-Yeste J, Corral-Sánchez MA, Marcello-Fernández M, Seoane-González J. Apendicectomía laparoscópica y embarazo. Experiencia personal y revisión de la bibliografía. Cir Esp 2005; 78:371-6. [PMID: 16420864 DOI: 10.1016/s0009-739x(05)70957-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pregnancy has been considered to be an absolute contraindication to the laparoscopic approach because of the theoretical effects of the pneumoperitoneum on the fetus and the occupation of the working space by the gravid uterus. Despite the growing literature on the subject, experience with frequent entities, such as acute appendicitis, is limited. OBJECTIVE The aim of this study was to report our experience with laparoscopic appendicectomy in pregnancy, to review the scientific evidence available on the safety of this procedure, and to establish the most relevant practical features for the use of this approach during pregnancy. MATERIAL AND METHODS We retrospectively reviewed six laparoscopic appendectomies performed in pregnant women. We also reviewed the available literature on well documented laparoscopic appendectomies during pregnancy. RESULTS All the procedures were laparoscopically completed. The mean operating time was 46 min. All patients were discharged within the first 48 postoperative hours. There were no surgical complications. All patients delivered healthy infants with appropriate weight for gestational age. For the literature review, 17 references were collected that included data on 94 laparoscopic appendectomies performed in pregnant women. There was only one fetal death associated with the surgical approach and the overall fetal mortality rate was less than that classically registered in the literature for the open approach. CONCLUSIONS Laparoscopic appendectomy in pregnant women is as safe and effective as the open approach and confers all the benefits of minimally invasive surgery.
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Affiliation(s)
- Carlos Moreno-Sanz
- Servicio de Cirugía General, Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real, Spain.
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Are C, Raman SP, Ravipatti N, Talamini M. Decreased Porcine Uterine Blood Flow During Laparoscopic Nissen Fundoplication. J Gynecol Surg 2004. [DOI: 10.1089/gyn.2004.20.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chandrakanth Are
- Department of General Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Siva P. Raman
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | - N. Ravipatti
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mark Talamini
- Department of Surgery and Minimally Invasive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Kolkman W, Scherjon SA, Gaarenstroom KN, Jansen FW. Laparoscopic management of adnexal masses with the open entry technique in second-trimester pregnancy. ACTA ACUST UNITED AC 2004. [DOI: 10.1007/s10397-004-0007-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rollins MD, Chan KJ, Price RR. Laparoscopy for appendicitis and cholelithiasis during pregnancy: a new standard of care. Surg Endosc 2003; 18:237-41. [PMID: 14691706 DOI: 10.1007/s00464-003-8811-8] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2003] [Accepted: 07/21/2003] [Indexed: 12/23/2022]
Abstract
BACKGROUND Subsequent to a report from the authors' institution, the laparoscopic management of symptomatic cholelithiasis and appendicitis during pregnancy has become the standard of care at LDS Hospital using institutional guidelines. For comparison with previous outcomes described by the authors, 59 additional laparoscopic cases are reported. METHODS Medical records of all pregnant patients at LDS Hospital who underwent open or laparoscopic cholecystectomy or appendectomy between 1998 and 2002 were reviewed. The outcomes were compared with the authors' previous data. RESULTS The laparoscopic management of symptomatic cholelithiasis and appendicitis during pregnancy increased from 54% to 97%. No significant differences in preterm delivery rates, birth weights, or 5-min Apgar scores were found between the two periods. No birth defects or uterine injuries occurred. CONCLUSIONS With the use of the authors' guidelines, laparoscopy has become the standard of care for managing symptomatic cholelithiasis and appendicitis during pregnancy at LDS Hospital without significant increase in morbidity or mortality.
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Affiliation(s)
- M D Rollins
- Department of Surgery, LDS Hospital, 8th Avenue and C Street, Salt Lake City, UT 84143, USA
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Abstract
OBJECTIVE To describe the long-term consequences of laparoscopic surgery during pregnancy. SUMMARY BACKGROUND DATA Laparoscopic surgery is well established in the surgical community. Laparoscopic surgery in the pregnant patient is not yet broadly accepted; concern has been for fetal wastage, effects of carbon dioxide (CO(2)) on the developing fetus, and long-term sequelae during childhood development. METHODS This report documents 11 laparoscopic cases in pregnancy with follow-up of 1 to 8 years. The patients were in their 16th to 28th week of pregnancy. Two patients had chronic cholecystitis and biliary colic resulting in weight loss and multiple admissions. Three patients had acute cholecystitis, and three patients had acute appendicitis. Two patients underwent exploration for a diagnosis of acute abdomen, and both were found to have small bowel obstruction. All patients had general anesthesia and underwent an open Hasson trocar procedure with end-tidal CO(2) monitoring, sequential compression devices, and partial left decubitus positioning. Insufflation pressure was maintained at 10 mm Hg. The operative time ranged from 25 to 90 minutes. RESULTS Successful laparoscopic surgery was performed in 10 cases, with one conversion to an open procedure. Intraoperative and postoperative fetal monitoring was performed for at least 24 hours. No fetal distress or demise occurred, nor were any tocolytics used. The resultant children were then monitored, and no evidence of developmental or physical abnormalities was detected during the study period. CONCLUSION Laparoscopic surgery is now proving to be as safe as open surgery in pregnancy. This article reports long-term follow-up with no deleterious effects to either mothers or children.
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Affiliation(s)
- Anne G Rizzo
- Department of Surgery, Washington Hospital Center, Washington, DC 20010, USA.
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General Principles of Minimally Invasive Surgery. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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de Perrot M, Jenny A, Morales M, Kohlik M, Morel P. Surg Laparosc Endosc Percutan Tech 2000; 10:368-371. [DOI: 10.1097/00019509-200012000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Curet MJ. Special problems in laparoscopic surgery. Previous abdominal surgery, obesity, and pregnancy. Surg Clin North Am 2000; 80:1093-110. [PMID: 10987026 DOI: 10.1016/s0039-6109(05)70215-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Previous surgery, obesity, and pregnancy should no longer be considered contraindications to laparoscopic surgery. Surgeons should exercise good judgement in patient selection, use meticulous surgical techniques, and prepare thoroughly for the planned procedure. Patients and surgeons should be aware of increased conversion rates. With these caveats in mind, these patients can still experience the advantages of minimally invasive surgery without increased risks.
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Affiliation(s)
- M J Curet
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, USA
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Abstract
Laparoscopic management of ectopic pregnancies is becoming more common. Having recently successfully treated one case of heterotopic pregnancy by laparoscopy in our department, the object of the present paper is to review the literature regarding laparoscopically treated cases of heterotopic pregnancy in order to assess benefits, complications and safety of this procedure. A Medline search yielded 10 additional cases with ampullary, interstitional or cornual tubal pregnancy, respectively. All surgical procedures were uncomplicated and all in utero pregnancies progressed normally. Despite a small number of cases, lack of complications in these reports is encouraging feasibility of laparoscopic management of heterotopic pregnancy.
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Affiliation(s)
- H Pschera
- Department of Obstetrics and Gynecology, Landeskrankenhaus, Leoben, Austria
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Hardwick RH, Slade RR, Smith PA, Thompson MH. Laparoscopic splenectomy in pregnancy. J Laparoendosc Adv Surg Tech A 1999; 9:439-40. [PMID: 10522542 DOI: 10.1089/lap.1999.9.439] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A laparoscopic splenectomy during pregnancy is described in this case report. The operation took place at 18 weeks' gestation for life-threatening thrombocytopaenia secondary to antiphospholipid syndrome that had failed to respond to medical therapy. The patient made a full and rapid recovery and was delivered of a healthy baby girl at term.
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Affiliation(s)
- R H Hardwick
- Department of Surgery, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
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Graham G, Baxi L, Tharakan T. Laparoscopic cholecystectomy during pregnancy: a case series and review of the literature. Obstet Gynecol Surv 1998; 53:566-74. [PMID: 9751939 DOI: 10.1097/00006254-199809000-00024] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study was conducted to evaluate the role of antepartum laparoscopic cholecystectomy (LC). Patients who underwent LC were identified from a hospital database with the use of CPT/ICD codes. Of 2093 cases performed at a major center (October 1991 to November 1997), only six were performed during pregnancy. On reviewing the English literature, gestational age at surgery and delivery and outcome of delivery were provided in only 69 of 105 patients (33 papers with 1-10 cases) and we tabulated different variables from the cases in this review. In this series, two patients who had LC in the first trimester underwent elective termination of pregnancy. Of the seven published cases of first trimester LC followed to delivery, one had preterm delivery. First trimester open cholecystectomy (OC) has a 12 percent spontaneous abortion rate. The four patients who had second trimester LC had normal deliveries at term. Of the 43 published cases of second trimester LC followed to delivery, 39 ended in uncomplicated, full-term deliveries. Three of four second trimester cases at one institution had spontaneous abortions. None of our patients underwent LC in the third trimester. Of the 12 published cases of third trimester LC followed to delivery, one had preterm delivery. Third trimester OC is reported to have a 40 percent rate of preterm delivery. There were no intraoperative cholangiograms (IOC), prophylactic or postoperative use of tocolytics, or intraoperative fetal monitoring in our series. We added six cases of LC during pregnancy to the previously reported 105 cases. The successful outcome in all trimesters suggests that LC is a safe procedure throughout pregnancy; however, surgery in the second trimester is preferable. Compared with OC, there is a decreased risk of spontaneous abortion in the first trimester and preterm labor in the third trimester.
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Affiliation(s)
- G Graham
- Department of Obstetrics and Gynecology, Sloane Hospital for Women, Columbia Presbyterian Medical Center, New York, New York 10032, USA
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