| Sospecha de apendicitis aguda en el tercer trimestre del embarazo: pros y contras de laparoscopía |
Suspicion of acute appendicitis in the third trimester of pregnancy: pros and cons of a laparoscopic procedure.
Donkervoort SC, Boerma D.
Onze Lieve Vrouwe Gasthuis, Department of Surgery, Amsterdam, The Netherlands.
JSLS. 2011 Jul-Sep;15(3):379-83.
Abstract
The presentation of acute appendicitis during pregnancy may cause diagnostic and therapeutic difficulty. Delay in diagnosis may lead to increased maternal and fetal risk. Therefore, an aggressive surgical approach is mandatory, even though this may result in an increased number of appendectomies for normal appendices. Diagnostic laparoscopy, followed by laparoscopic appendectomy in case of inflammation, seems a logical strategy. We present the case of a 36-week pregnant woman who presented with suspicion of acute appendicitis. The pro and cons of a laparoscopic approach in the third trimester of pregnancy are discussed as is its safety by reviewing the literature
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| Apendicectomía laparoscópica en todos los trimestres del embarazo |
Laparoscopic appendicectomy in all trimesters of pregnancy.
Machado NO, Grant CS.
Department of Surgery, Sultan Qaboos University Hospital, Muscat/Sultanate of Oman. norman@omantel.net.om
JSLS. 2009 Jul-Sep;13(3):384-90.
Abstract
BACKGROUND: The laparoscopic approach for appendicectomy in pregnancy was not considered the preferred procedure until recently. The aim of this study was to examine our experience with laparoscopic appendicectomy in pregnancy and review the scientific evidence available in the medical literature. METHOD: The clinical data of all patients who underwent laparoscopic appendicectomy during pregnancy at our hospital between 1999 and 2007 were collected and retrospectively analyzed. A Medline literature search restricted to English language articles on laparoscopic appendicectomy in pregnancy was carried out. RESULT: Twenty patients underwent laparoscopic appendicectomy during pregnancy. Of these, 8 were in the first trimester, 9 in the second trimester, and 3 in the third trimester. Fifteen patients had histologically confirmed appendicitis. The mean operating time was 45 minutes, and the average postoperative stay in the hospital was 1.5 days. All patients except one had a full-term normal delivery. Literature search: An additional 637 patients from the English literature were reviewed and summarized. CONCLUSION: Our results demonstrate that laparoscopic appendicectomy can be safely performed during all trimesters of pregnancy. The literature search suggests that although laparoscopic appendicectomy in pregnancy is associated with a low rate of intraoperative complications in all trimesters it may be associated with a significantly higher rate of fetal loss compared with open appendicectomy.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015967/pdf/jsls-13-3-384.pdf
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| Apendicectomía laparoscópica y embarazo. Experiencia personal y revisión de la literatura |
Laparoscopic appendicectomy and pregnancy. Personal experience and review of the literature.
Moreno-Sanz C, Pascual-Pedreño A, Picazo-Yeste J, Corral-Sánchez MA, Marcello-Fernández M, Seoane-González J.
Servicio de Cirugía General, Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real, Spain. drmoreno@laparoscopia-online.com
Cir Esp. 2005 Dec;78(6):371-6.
Abstract
INTRODUCTION: Pregnancy has been considered to be an absolute contraindication to the laparoscopic approach because of the theoretical effects of the pneumoperitoneum on the fetus and the occupation of the working space by the gravid uterus. Despite the growing literature on the subject, experience with frequent entities, such as acute appendicitis, is limited. OBJECTIVE: The aim of this study was to report our experience with laparoscopic appendicectomy in pregnancy, to review the scientific evidence available on the safety of this procedure, and to establish the most relevant practical features for the use of this approach during pregnancy. MATERIAL AND METHODS: We retrospectively reviewed six laparoscopic appendectomies performed in pregnant women. We also reviewed the available literature on well documented laparoscopic appendectomies during pregnancy. RESULTS: All the procedures were laparoscopically completed. The mean operating time was 46 min. All patients were discharged within the first 48 postoperative hours. There were no surgical complications. All patients delivered healthy infants with appropriate weight for gestational age. For the literature review, 17 references were collected that included data on 94 laparoscopic appendectomies performed in pregnant women. There was only one fetal death associated with the surgical approach and the overall fetal mortality rate was less than that classically registered in the literature for the open approach. CONCLUSIONS: Laparoscopic appendectomy in pregnant women is as safe and effective as the open approach and confers all the benefits of minimally invasive surgery.
http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13082152&pident_usuario=0&pcontactid=&pident_revista=36&ty=139&accion=L&origen=elsevier&web=www.elsevier.es&lan=es&fichero=36v78n06a13082152pdf001.pdf
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| Anestesia para cirugía no obstétrica en la embarazada |
Anesthesia for non-obstetric surgery in the pregnant patient.
Van De Velde M, De Buck F.
Department of Anesthesiolog, University Hospitals Gasthuisberg, Catholic University of Leuven, Leuven, Belgium. marc.vandevelde@uz.kuleuven.ac.be
Minerva Anestesiol. 2007 Apr;73(4):235-40.
Abstract
Surgery during pregnancy is relatively common. The present review of the literature will focus on relevant issues such as maternal safety during non-obstetric surgery in pregnancy, teratogenicity of anesthetic drugs, the avoidance of fetal asphyxia, the prevention of preterm labor, the safety of laparoscopy, the need to monitor the fetal heart rate and will finally give a practical approach to manage these patients
http://www.minervamedica.it/en/journals/minerva-anestesiologica/article.php?cod=R02Y2007N04A0235 |
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