Acute appendicitis in pregnancy - do we treat correctly, or do we delay unnecessarily?

IF 1.2 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Ginekologia polska Pub Date : 2024-01-01 Epub Date: 2023-09-05 DOI:10.5603/gpl.95367
Petra Guňková, Lubomír Tulinský, Daniel Toman, Lubomír Martínek, Adéla Vrtková, Richard Špaček, Ondřej Šimetka
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Abstract

Objectives: Acute appendicitis is the most common non-gynaecological indication for surgical intervention during pregnancy. The aim of this study was to compare perioperative and postoperative results of surgical treatment of acute appendicitis in the early and late stage of pregnancy.

Material and methods: This is a retrospective study focused on the evaluation of perioperative and postoperative results of appendectomy in pregnancy. The study included all pregnant patients who underwent laparoscopic or open appendectomy at the University Hospital Ostrava during the observed 10-year period (January 2012-December 2021). The patients were divided into two subgroups according to the stage of pregnancy in relation to the expected viability of the foetus (the viability limit was defined as the 23rd week of pregnancy).

Results: In the monitored 10-year period, a total of 25 pregnant patients underwent appendectomy. Comparing the two subgroups of patients, there were no statistically significant differences in any of the admission parameters. Laparoscopy was performed in 100% of the patients in the lower stage of pregnancy (< 23 g.w.) and in 61% of the subgroup of patients with more advanced pregnancy (> 23 g.w.); this difference was statistically significant (p = 0.039). Differences in subgroups regarding duration of surgery, risk of revision and 30-day postoperative morbidity were not statistically significant. In the subgroup of patients < 23 g.w., uncomplicated forms of appendicitis predominated (66%), whereas in the subgroup > 23 g.w., complicated forms predominated (69%); this difference was statistically significant (p = 0.026). When comparing the two subgroups of patients, there was a statistically significant difference in the length of hospitalization (p = 0.006). The mortality rate of the group was zero.

Conclusions: The results of the study confirm the fact that advanced pregnancy may be related to complicated forms of appendicitis. Therefore, early appendectomy is still the method of choice. In accordance with the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recommendations, laparoscopic approach is preferred in pregnant patients, even in advanced pregnancy.

妊娠期急性阑尾炎--是正确治疗,还是不必要的延误?
目的:急性阑尾炎是妊娠期最常见的非妇科手术指征。本研究旨在比较妊娠早期和晚期急性阑尾炎手术治疗的围手术期和术后效果:这是一项回顾性研究,主要评估妊娠期阑尾切除术的围手术期和术后效果。研究对象包括观察期10年(2012年1月至2021年12月)内在俄斯特拉发大学医院接受腹腔镜或开腹阑尾切除术的所有妊娠期患者。根据与胎儿预期存活率相关的怀孕阶段(存活率界限定义为怀孕第23周),将患者分为两个亚组:在监测的 10 年间,共有 25 名孕妇接受了阑尾切除术。两组患者的入院参数在统计学上没有明显差异。100%的低孕期(体重小于23克)患者和61%的高孕期(体重大于23克)亚组患者都接受了腹腔镜手术;这一差异具有统计学意义(P = 0.039)。各亚组在手术时间、翻修风险和术后 30 天发病率方面的差异无统计学意义。在体重<23 g.w.的亚组患者中,无并发症型阑尾炎占多数(66%),而在体重>23 g.w.的亚组患者中,并发症型阑尾炎占多数(69%);这一差异有统计学意义(p = 0.026)。比较两组患者的住院时间,差异有统计学意义(p = 0.006)。该组的死亡率为零:研究结果证实,晚期妊娠可能与复杂性阑尾炎有关。因此,早期阑尾切除术仍是首选方法。根据美国胃肠道和内窥镜外科医生协会(SAGES)的建议,妊娠患者应首选腹腔镜方法,即使是晚期妊娠。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Ginekologia polska
Ginekologia polska OBSTETRICS & GYNECOLOGY-
CiteScore
2.00
自引率
15.40%
发文量
317
审稿时长
4-8 weeks
期刊介绍: Ginekologia Polska’ is a monthly medical journal published in Polish and English language. ‘Ginekologia Polska’ will accept submissions relating to any aspect of gynaecology, obstetrics and areas directly related. ‘Ginekologia Polska’ publishes original contributions, comparative works, case studies, letters to the editor and many other categories of articles.
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