Laparoscopic appendectomy during pregnancy: an evidence-based review

Dear Editor,We commend Jackson et al. for an interesting review of therole of laparoscopic surgery for surgical diseases duringpregnancy [1]. They note that, in pregnancy, ‘‘laparoscopicappendectomy is considered by many to be the standard ofcare’’. However, we wish to highlight certain issuesregarding laparoscopic appendectomy (LA) in pregnantpatients which we believe are significant.Although more than 600 cases of LA in pregnancy havebeen reported (and likely many more performed), much ofthe data are limited to individual case reports and smallcase series. McGory et al. recently reported 454 cases ofLA in pregnancy, by far the largest series documented todate [2]. A subsequent publication from our unit incorpo-rated an additional 183 cases from the literature, yielding asystematic review of 637 cases of LA in pregnancy [3]. Wefound that, although the rate of intraoperative complica-tions during LA in pregnancy was low, the incidence offetal loss following LA was significantly higher (5.6%)than following open appendectomy (3.1%, p