Our Summary

This research paper discusses a set of guidelines created by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) for pregnant women who may need surgery for non-pregnancy related issues such as appendicitis, gallbladder disease, and inflammatory bowel disease. The team of experts reviewed existing literature and studies on these topics and came up with a list of recommendations based on their findings.

They suggest that removing the appendix is better than not operating when a pregnant woman has appendicitis. They also recommend using a minimally invasive surgery (laparoscopic) over open surgery for removing the appendix. The same recommendation applies for gallbladder disease. However, for gallbladder disease not related to acute inflammation (cholecystitis), either operative or non-operative treatment can be considered in the third trimester of pregnancy.

For patients with symptomatic gallstones in the bile duct (choledocholithiasis), they suggest a procedure called endoscopic retrograde cholangiopancreatography, which is used to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas.

The guidelines further suggest that the decision to perform emergency surgery in pregnant women with inflammatory bowel disease should be based on the same criteria as non-pregnant patients. However, if surgery is required, an open surgical approach is recommended over a minimally invasive approach. They also recommend that pregnant patients with active inflammatory bowel disease should be managed by a team of experts at centers that specialize in this disease.

FAQs

  1. What is the suggested procedure for pregnant women with appendicitis according to the guidelines by the Society of American Gastrointestinal and Endoscopic Surgeons?
  2. What are the recommendations for treating gallbladder disease in pregnant women, especially in the third trimester?
  3. How should pregnant women with active inflammatory bowel disease be managed according to the guidelines by the Society of American Gastrointestinal and Endoscopic Surgeons?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laparoscopic appendectomy is to follow post-operative care instructions carefully to ensure a smooth recovery. This may include taking prescribed pain medication, avoiding heavy lifting or strenuous activity for a certain period of time, and maintaining good hygiene to prevent infection at the incision site. It is also important to follow up with your doctor for any concerns or complications that may arise after the procedure.

Suitable For

In summary, patients who are typically recommended for laparoscopic appendectomy are pregnant women with appendicitis, as well as those with gallbladder disease that is not related to acute inflammation. Patients with symptomatic gallstones in the bile duct may also be recommended for endoscopic retrograde cholangiopancreatography. However, for pregnant women with inflammatory bowel disease, an open surgical approach is recommended over laparoscopic surgery if surgery is required. It is important for pregnant patients with active inflammatory bowel disease to be managed by a team of experts at specialized centers.

Timeline

Before laparoscopic appendectomy:

  1. Patient experiences symptoms of appendicitis such as abdominal pain, nausea, and vomiting.
  2. Patient undergoes physical examination and diagnostic tests such as blood tests and imaging studies to confirm the diagnosis.
  3. Surgeon discusses treatment options with the patient, including the option of laparoscopic appendectomy.
  4. Patient receives pre-operative instructions and is scheduled for surgery.

After laparoscopic appendectomy:

  1. Patient undergoes laparoscopic appendectomy, a minimally invasive surgery that involves making small incisions in the abdomen and using a camera to remove the appendix.
  2. Patient is monitored in the recovery room before being transferred to a hospital room.
  3. Patient may experience some pain and discomfort post-surgery, which is managed with pain medications.
  4. Patient is encouraged to walk and resume normal activities as soon as possible to aid in recovery.
  5. Patient is discharged from the hospital within a few days and instructed on post-operative care and follow-up appointments.
  6. Patient typically experiences a quicker recovery time and less scarring compared to open surgery.

What to Ask Your Doctor

  1. What is the success rate of a laparoscopic appendectomy in pregnant women?
  2. Are there any potential risks or complications associated with this procedure during pregnancy?
  3. How soon after surgery can I expect to recover and resume normal activities?
  4. Will there be any impact on my pregnancy or the health of my baby?
  5. What alternative treatment options are available for appendicitis during pregnancy?
  6. How experienced is the surgical team in performing laparoscopic appendectomies on pregnant women?
  7. How will pain management be handled post-surgery, considering the pregnancy?
  8. What follow-up care or monitoring may be required after the procedure?
  9. Are there any specific dietary or lifestyle recommendations I should follow after the surgery?
  10. Are there any potential long-term effects on my health or pregnancy as a result of having a laparoscopic appendectomy?

Reference

Authors: Kumar SS, Collings AT, Wunker C, Athanasiadis DI, DeLong CG, Hong JS, Ansari MT, Abou-Setta A, Oliver E, Berghella V, Alli V, Hassan I, Hollands C, Sylla P, Slater BJ, Palazzo F. Journal: Surg Endosc. 2024 Jun;38(6):2947-2963. doi: 10.1007/s00464-024-10810-1. Epub 2024 May 3. PMID: 38700549