Laparoscopic appendectomy during pregnancy

Appendectomy is the most common nonobstetric operation during pregnancy, but laparoscopy has not been considered to be the preferred procedure until recently. The objective of this study was to report the authors' experience with laparoscopic appendectomy during pregnancy and to review the available literature. Six patients underwent laparoscopic appendectomy during pregnancy, and 24 additional cases from the literature were reviewed. Two patients underwent surgery during the first trimester of pregnancy, three patients underwent surgery during the second trimester, and one patient underwent surgery during the third trimester. The Hasson open technique was used in five cases, and the Veress needle was used in one case. Port site locations were adapted to the size of the gravid uterus. Three patients had histologically confirmed appendicitis and underwent delivery of a neonate after 36 weeks (n = 1) and 37 weeks (n = 2) of gestation. Two patients had uterine infections and underwent abortions 2 days after surgery and 6 weeks after surgery, respectively. One patient had an isolated torsion of the right fallopian tube that was diagnosed using laparoscopy. These results show that laparoscopic appendectomy can be safely performed during pregnancy. One limitation may be the size of the gravid uterus, which interferes with adequate visualization and instrumentation in the third trimester of pregnancy.