Robert M Dorman, MD1, Carroll M Harmon, MD, PhD2, Aaron Hoffman, MD1. 1University of Buffalo, 2Women and Children’s Hospital of Buffalo
Introduction: The aim of this study was to evaluate the experience of one surgeon at one hospital in performing abdominal non-obstetric surgery on pregnant patients over 6 years.
Methods: A retrospective chart review of all relevant procedures was performed, noting maternal demographics, estimated gestational age (EGA), type and details of procedure, and pre- and post-operative course to 30 days.
Results: Twenty-nine pregnant patients underwent 29 abdominal procedures from September 2007 to July 2013 at a dedicated women and children’s hospital. Of these, 18 (62%) were laparoscopic appendectomies, 8 (28%) were laparoscopic cholecystectomies, one was an open umbilical hernia repair, one was a laparoscopic reduction of an internal hernia following previous roux-en-Y gastric bypass, and one was an open repair of a ruptured spontaneous splenic artery aneurysm with splenectomy. Mean maternal age was 25.9 years (standard deviation (SD) 6.0, range 17-42) and mean estimated gestational age (EGA) was 19.7 weeks (SD 8.5); 6, 14, and 7 patients with a recorded EGA were in the 1st, 2nd, and 3rd trimesters, respectively. Mean operative time for appendectomy was 34.6 minutes (SD 12.1, range 18-55), and for cholecystectomy was 40.3 minutes (SD 22.7, range 20-87). Among patients undergoing appendectomy, 5 were found to be perforated, 3 to have a normal appendix (1 of whom had a torsed ovary), and 1 to have granulomatous appendicitis. All appendices and mesoappendices were divided with an endoscopic stapler. In consecutive thirds of appendectomy experience, mean operative time decreased from 40 to 37 to 26 minutes. Indications for cholecystectomy included gallstone pancreatitis, choledocholithiasis, biliary colic leading to malnutrition, and acute cholecystitis. No patients entered labor during their hospital course. There were 4 postoperative complications in 3 patients (10%), including 2 ileus, 1 UTI, and 1 superficial wound infection. One patient had 2 readmissions for persistent emesis after cholecystectomy. There were no reoperations or deaths.
Conclusion: Abdominal surgery is safe and feasible in pregnant patients in all trimesters, although it remains prudent to aim for the 2nd trimester or postpartum when feasible. We see no contraindication to laparoscopy in pregnant patients when the surgeon has a degree of comfort and experience in performing a given procedure with this approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79271
Program Number: P604
Presentation Session: Poster (Non CME)
Presentation Type: Poster