Laparoscopic appendectomy during pregnancy

Appendectomy is the most common nonobstetric operation during pregnancy, bu t laparoscopy has not been considered to be the preferred procedure until r ecently. 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 pregna ncy, and 24 additional cases from the literature were reviewed. Two patient s underwent surgery during the first trimester of pregnancy, three patients underwent surgery during the second trimester, and one patient underwent s urgery during the third trimester. The Hasson open technique was used in fi ve cases, and the Veress needle was used in one case. Port site locations w ere adapted to the size of the gravid uterus. Three patients had histologic ally confirmed appendicitis and underwent delivery of a neonate after 36 we eks (n = 1) and 37 weeks (n = 2) of gestation. Two patients had uterine inf ections and underwent abortions 2 days after surgery and 6 weeks after surg ery, respectively. One patient had an isolated torsion of the right fallopi an tube that was diagnosed using laparoscopy. These results show that lapar oscopic appendectomy can be safely performed during pregnancy. One limitati on may be the size of the gravid uterus, which interferes with adequate vis ualization and instrumentation in the third trimester of pregnancy.