Gestational Age-Adapted Laparoscopic Appendectomy for Acute Appendicitis during Pregnancy: Intraoperative Strategies and Outcomes from a Single-Center Case Series.

INTRODUCTION

Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy, occurring in approximately 1 in 1000-2000 pregnancies. Although laparoscopic appendectomy (LA) offers advantages over open appendectomy, including reduced postoperative pain and a shorter hospital stay, its application in pregnant patients remains debated due to concerns about fetal effects and the technical challenges posed by the enlarged uterus.

CASE PRESENTATION: We retrospectively reviewed 6 consecutive pregnant women who underwent LA for acute appendicitis at our institution between April 2020 and April 2025, focusing on intraoperative techniques and surgical outcomes. Patient age ranged from 28 to 37 years (median, 31.5 years) and gestational age from 15 to 33 weeks (median, 21.0 weeks). All cases were completed laparoscopically using a 3-port technique, with intraperitoneal insufflation pressure maintained at 10-12 mmHg. A supine position was used in 4 cases (≤20 weeks of gestation) and a left lateral decubitus position in 2 cases (≥21 weeks). The median operative time was 84 min (range, 64-124 min), blood loss was 0 g in 5 cases (5 g in 1), and the median postoperative hospital stay was 5 days (range, 2-7 days). Pathological findings included 1 catarrhal, 4 phlegmonous, and 1 gangrenous appendicitis. No conversions to open surgery occurred, and no obstetric complications were observed in any case.

CONCLUSIONS

By tailoring patient positioning and port placement to gestational age, LA was safely performed during the 2nd and 3rd trimesters. LA appears to be a safe and effective treatment for acute appendicitis during pregnancy when appropriate intraoperative precautions are applied.