Laparoscopic Versus Open Appendectomy for Appendicitis in Pregnancy: Systematic Review and Meta-Analysis

Objectives: The clinical safety, efficacy and feasibility of laparoscopic appendectomy (LA) compared with open appendectomy (OA) in pregnancy are still controversial. Herein, we are aiming to compare the clinical outcomes of LA and OA in patients with acute appendicitis during their pregnancy. Materials and Methods: This was a systematic review and meta-analysis of studies comparing laparoscopic and OA in pregnancy identifying using PubMed, Web of science, Embase, The Cochrane Library, Ovid and Scopus. Two independent reviewers extracted data on surgical complication, fetal loss, preterm delivery, hospital stay, Apgar score in both groups. Results: Twenty-seven studies with total of 6497 patients (4464 in open and 2031 in laparoscopic group) were included. LA was associated with lower rate of wound infection [odds risk (OR) = 3.13, 95% confidence interval (CI): 1.77-5.56, P < 0.0001] overall complications (OR = 2.15, 95% CI: 1.47-3.14, P < 0.0001) and shorter hospitalization (mean difference = 0.72, 95% CI: 0.43-1.02, P < 0.00001) compared with open group. LA was in a lower risk for 5-minute Apgar score (mean difference = 0.09, 95% CI: 0.02-0.17, P = 0.01) group than open group. No difference was found regarding preterm delivery between 2 groups. LA was associated with higher fetal loss (OR = 0.57, 95% CI: 0.41-0.79, P = 0.0007) compared with open surgery. However, laparoscopy was not associated with increased fetal loss after 2010 (OR = 0.74, 95% CI: 0.44-1.24, P = 0.26) compared with open group. Conclusions: LA in pregnancy seems to be feasible with acceptable outcome, especially in patients with early and mid-trimester period, with sophisticated hands and experienced centers.