| Aim: To determine the efficacy and safety of laparoscopic(LA)and open approach(OA)in pregnant women with acute appendicitis.Methods: We searched studies published from Jan.2005 to Mar.2019 which compared the surgical and obstetrical outcomes of LA and OA for pregnant women with acute appendicitis.The search database includes large-scale comprehensive databases such as Pubmed,Embase,Cochrane Library,CNKI and Wanfang database.The quality of study was evaluated using the the Methodological Index for Non-Randomized Studies(MINORS)and improved Jadad Scale.Finally,statistical analyses were carried out with RevMan version 5.3.Results:A total of 6640 pregnant women from twenty-two studies were included in meta-analysis.2126 in the LA group and 4514 in the OA group,Meta-analysis suggested that the LA group had shorter operative time(MD =-2.33,95% CI:-3.09,-1.58,P <0.001)?hospital stays(MD =-2.33,95% CI:-3.09,-1.58,P <0.001)and Time to first flatus(MD =-1.69,95% CI:-1.98,-1.41,P <0.001),less intraoperative blood loss(MD=-20.51,95% CI:-26.40,-14.63,P <0.001),lower postoperative complication rates(OR = 0.26,95% CI = 0.16,0.43,P <0.001),lower preterm birth rates(OR = 0.45,95% CI = 0.33,0.63,P <0.001),higher rates of fetal loss(OR = 1.81,95% CI = 1.30,2.52,P <0.001);No statisticallysignificant differences were found in gestational age for term deliveries,birth weight,caesarean section rates.Conclusion: The data showed that laparoscopic appendectomy is related to significantly shorter operative time?hospital stays and time to first flatus,less intraoperative blood loss,lower postoperative complication rates,lower preterm birth rates,higher rates of fetal loss.Thus,current literature remains inconclusive on the optimal approach of appendectomy in pregnant women.However further high quality and larger-volume studies are needed in order to elucidate the critical effect of laparoscopic appendectomy on fetal loss rates and assess long-term outcomes. |
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