Laparoscopic negative appendectomy during pregnancy is associated with adverse neonatal outcome

Abstract

Background: The impact on pregnancy of laparoscopy for acute appendicitis is well documented. However, with an accurate pre-operative diagnosis being more challenging in pregnant patients, the incidence of a negative appendectomy (NA) is higher in this cohort. The aim of this study was to evaluate the maternal and neonatal implications of a NA during pregnancy.

Methods: A single center retrospective study between 2004 and 2019 was performed. Pregnant women who underwent laparoscopic appendectomy for suspected appendicitis were identified from which those who had a pathologically normal appendix were selected. The maternal and neonatal outcome of this group were compared with a matched control group of pregnant women who underwent diagnostic laparoscopy for a presumed ovarian torsion in whom no further surgical intervention was performed. Multivariate regression analysis was performed to explore factors that gestational size.

Results: Of the 225 pregnant women who underwent laparoscopy appendectomy, a NA was performed in 33 (14.7%). These were compared with 50 pregnant women in the diagnostic laparoscopy group. The former was characterized by higher rate of nulliparity and later gestational age at the time of the surgery (17.8 ± 7.5 vs 11.3 ± 6.3, p < 0.001). Whilst the rate of maternal complications during pregnancy were similar between the groups, NA was associated with significantly lower neonatal birthweights (2733.9 ± 731.1 vs 3200.7 ± 458.5 g, p = 0.002) and a significantly higher risk of small for gestational age (SGA) infants (OR 5.6, 95% CI 1.02-30.9).

Conclusions: Performing a NA during pregnancy is an indicator for perioperative counseling and antenatal follow up.

Keywords: Appendicitis; Laparoscopy; Negative-appendectomy; Pregnancy.

Fig. 1

A flow diagram of patients involved in each of the two groups, intra-operative findings and the number of infants born into each cohort