Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Dec;36(12):8699-8712.
doi: 10.1007/s00464-022-09625-9. Epub 2022 Oct 28.

EAES rapid guideline: systematic review, meta-analysis, GRADE assessment, and evidence-informed European recommendations on appendicitis in pregnancy

Michel Adamina  1 , Anthoula Andreou  1 , Alberto Arezzo  2 , Christos Christogiannis  3 , Nicola Di Lorenzo  4 , Meropi Gioumidou  1 , Julie Glavind  5 , Christos Iavazzo  6 , Dimitrios Mavridis  3   7 , Filip E Muysoms  8 , Daniel Preda  9 , Neil J Smart  10 , Aggeliki Syropoulou  1 , Alexander Α Tzanis  11 , Marc Van de Velde  12 , Joeri Vermeulen  13   14 , Stavros A Antoniou  15
Affiliations
Meta-Analysis

EAES rapid guideline: systematic review, meta-analysis, GRADE assessment, and evidence-informed European recommendations on appendicitis in pregnancy

Michel Adamina et al. Surg Endosc. 2022 Dec.

Abstract

Background: Clinical practice recommendations for the management of acute appendicitis in pregnancy are lacking.

Objective: To develop an evidence-informed, trustworthy guideline on the management of appendicitis in pregnancy. We aimed to address the questions of conservative or surgical management, and laparoscopic or open surgery for acute appendicitis.

Methods: We performed a systematic review, meta-analysis, and evidence appraisal using the GRADE methodology. A European, multidisciplinary panel of surgeons, obstetricians/gynecologists, a midwife, and 3 patient representatives reached consensus through an evidence-to-decision framework and a Delphi process to formulate the recommendations. The project was developed in an online authoring and publication platform (MAGICapp).

Results: Research evidence was of very low certainty. We recommend operative treatment over conservative management in pregnant patients with complicated appendicitis or appendicolith on imaging studies (strong recommendation). We suggest operative treatment over conservative management in pregnant patients with uncomplicated appendicitis and no appendicolith on imaging studies (weak recommendation). We suggest laparoscopic appendectomy in patients with acute appendicitis until the 20th week of gestation, or when the fundus of the uterus is below the level of the umbilicus; and laparoscopic or open appendectomy in patients with acute appendicitis beyond the 20th week of gestation, or when the fundus of the uterus is above the level of the umbilicus, depending on the preference and expertise of the surgeon.

Conclusion: Through a structured, evidence-informed approach, an interdisciplinary panel provides a strong recommendation to perform appendectomy for complicated appendicitis or appendicolith, and laparoscopic or open appendectomy beyond the 20th week, based on the surgeon's preference and expertise.

Guideline registration number: IPGRP-2022CN210.

Keywords: AGREE-S; Appendectomy; Appendicitis; EAES; Guideline; Pregnancy.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Zingone F, Sultan AA, Humes DJ, West J (2015) Risk of acute appendicitis in and around pregnancy: a population-based cohort study from England. Ann Surg 261(2):332–337. https://doi.org/10.1097/SLA.0000000000000780 (PMID: 24950289) - DOI - PubMed
    1. Mourad J, Elliott JP, Erickson L, Lisboa L (2000) Appendicitis in pregnancy: new information that contradicts long-held clinical beliefs. Am J Obstet Gynecol 182(5):1027–1029. https://doi.org/10.1067/mob.2000.105396 (PMID: 10819817) - DOI - PubMed
    1. Weinstein MS, Feuerwerker S, Baxter JK (2020) Appendicitis and cholecystitis in pregnancy. Clin Obstet Gynecol 63(2):405–415. https://doi.org/10.1097/GRF.0000000000000529 (PMID: 32187083) - DOI - PubMed
    1. Tinoco-González J, Rubio-Manzanares-Dorado M, Senent-Boza A, Durán-Muñoz-Cruzado V, Tallón-Aguilar L, Pareja-Ciuró F, Padillo-Ruíz J (2018) Acute appendicitis during pregnancy: differences in clinical presentation, management, and outcome. Emergencias 30(4):261–264 (PMID: 30033700) - PubMed
    1. EAES Guidelines Subcommittee. Living review of surgical guidelines. Available in: https://eaes.eu/about-eaes/committees/consensus-guideline-subcommittee-p... . Accessed June 19 2022

Publication types

LinkOut - more resources