Laparoscopic or open appendicectomy for suspected appendicitis in pregnancy and evaluation of foetal outcome in Australia
The safest surgical approach for suspected appendicitis in pregnancy remains controversial. Multiple large series attest to the safety of laparoscopic surgery in pregnancy, despite earlier concerns relating to changes in intra‐abdominal pressures and relative hypercarbia.9 Most previous studies looking at open versus laparoscopic appendicectomy (LA) in pregnancy were underpowered to detect any benefit of either surgical approach, resulting in conflicting conclusions. However, a recent systematic review by Wilasrusmee et al.10 pooled these studies and found that there was a statistically significant increase in the risk of foetal loss in the laparoscopic group compared with open surgery (relative risk (RR) 1.91). Preterm labour rates, hospital length of stay (LOS) and perinatal complications were similar.
The Wilasrusmee review was heavily influenced by one paper (contributing 87.65% of the data). This study was a retrospective analysis of case files from California, which did not account for maternal and gestational age – both independent determinants of foetal loss rates. Furthermore, gestational age is a likely determinant in surgical approach and hence a significant confounder in this study.
We hypothesized that the LA group would have an over‐representation of early gestational ages compared with the open appendicectomy (OA), and accordingly, the difference in risk of foetal loss between LA and OA may be explained by the inherently higher risks of foetal loss earlier in pregnancy. In order to more accurately determine the influence of surgical approach, we sought to evaluate the risks of foetal loss in pregnant woman following laparoscopic or OA for suspected appendicitis adjusting for these factors.