My choice was laparoscopic surgery.

and my opinion, its complication was not differ open and laparoscopy appendectomy.

If there were no other risk factors besides pregnancy itself :) I would definitely prefer laparoscopic approach using loop suture or stapler. And of course I would enter abdomen under direct visual control then placing troacar after I have avoided blind entry to peritoneal cavity. Good luck!

I prefer laparoscopy for appendectomy. A systematic review and meta-analysis of studies comparing lap and open appendectomy published in BJS (Br J Surg. 2012 November; 99(11): 1470–1478.) shows that the available low grade evidence suggests that laparoscopic appendicectomy in pregnant women might be associated with a greater risk of fetal loss. We need good studies and its a very important question that you have asked.

Thank you everyone for your comments, it is interesting in a way that there are not much significant differences of either appendectomy have been found due to complications varies so that in my opinion As Alfie Kavalakat has just mentioned that there are chances to have fetal defect/ fetal loss due to laparoscopic appendectomy and several published papers have also found to be the same thats why depending upon the patient's conditions a surgeon should consider which one would be the best.....Thanks.

New comparative study published in J Matern Fetal Neonatal Med. 2013 Jun 24.

"Appendectomy during Pregnancy- Is Pregnancy Outcome Depending by Operation Technique? "

http://www.ncbi.nlm.nih.gov/pubmed/23795902

Thank you dear Alfie Kavalakat for your links, its really useful. it has shown that laparoscopic Appendectomy is still superior to open Appendectomy. many thanks.

It is a good idea to keep it simple. Creation of pneumoperitoneum is associated with alteration of haemodynamics in several intra-abdominal organs, which can lead to serious consequences, so it is advisable to avoid laparoscopic appendicectomy during pregnancy. Inducing premature labour or miscarriages after the procedure can not be defended.

Laparoscopic appendicectomy is preferred. However, care should be taken to avoid insufflating the gravid uterus with CO2, as this was reported to cause foetal death. Another technical trick is to place trocar at higher sites than usual and not to overinsufflate the abdomen. Problem is usually with the narrow operative space.

In my opinion, laparoscopic surgery. We have published 2 articles on the benefits:

1. Palanivelu C, Rangarajan M, Parthasarathi R. Laparoscopic Appendectomy in Pregnancy: a Case Series of Seven Patients. JSLS 2006;10:321–325

2. Palanivelu C, Rangarajan M, Senthilkumaran S, Parthasarathi R. Safety and Efficacy of Laparoscopic Surgery in Pregnancy: Experience of a Single Institution. J Lap Adv Surg Tech 2007;17(2):186-190

I believe the literature supports both options as feasible and safe.

Laproscopic appendectomy in pregnancy is associated with foetal loss upto 7%.Open appendectomy is still a safe option

Hi Dr.Gurung,

I think laparoscopy appendectomy in second to third trimester pregnant women is safe. Please refer to our publication:

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015692/

There are articles that report safety of laparoscopy appendectomy in all semesters of pregnancy :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015967/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015692/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015967/

laparoscopic and open appendectomy are equally safe. Increased fetal loss rate is not due to the type of operation but due to the stage of appendiceal inflammation. Fetal loss rate is the same for simple appnedicitis, negative appendectomy and 'normal' pregnancy in general.

I published a book on the subject by Springer in 2014

http://www.springer.com/medicine/surgery/book/978-3-319-05421-6

laparoscopic and open appendectomy are equally safe. Increased fetal loss rate is not due to the type of operation but due to the stage of appendiceal inflammation. Fetal loss rate is the same for simple appendicitis, negative appendectomy and 'normal' pregnancy in general.

I published a book on the subject by Springer in 2014

http://www.springer.com/medicine/surgery/book/978-3-319-05421-6

1. Laparoscopic appendectomy has not superseded Open Appendectomy fully as the standard routine procedure to treat acute appendicitis. Compared to Laparoscopic Cholecystectomy which has replaced Open with Laparoscopic Cholecystectomy as the gold standard procedure of choice for the treatment of symptomatic gallstones. Few reasons worth noting:

-for a thin, low BMI patient, especially in children and young adults, Open Appendectomy can be performed expeditiously by all surgeons of all ranks with minimal risk.for this group of patients, laparoscopic appendectomy is not clinically logical and to embark on a randomised controlled trial to assess the values of these procedures to compare with open procedure is not a reasonable research question.

-for an obese female patients, diagnostic laparoscopy in a patient with clinically suspicious diagnosis of Acute Appendicitis is a clinically logical procedure to perform. once acute appendicitis is confirmed at Diagnostic Laparoscopy, the surgeon can continue to perform Laparoscopic Appendectomy with ease and safety. this group of patients will benefit greatly from the reduced scars as compared to the potential large scars in an otherwise open procedure.

2. For a second trimester pregnancy, the volume of the gravid uterus and the displacement of the appendix might mitigate against the success of Laparoscopic Appendectomy. 

In a thin pregnant lady,its perhaps safer to preoperatively locate the point of maximum tenderness to mark the skin for the transverse incision overlying the displaced appendicular stump.

An obese gravid patient with uncertain diagnosis of appendicitis is perhaps worthwhile to start with Diagnostic Laparoscopy and proceed to Appendectomy either laparoscopically or by conversion to open based on the factors discussed above.

I agree with Hamin. But if you take all these facts together it is better to have excellent training and expertize in laparosocopic appendectomy so the surgeon could have less preoperative strategic difficulties. When I started laparoscopic appendectomy it was easier for me to do open appendectomy. Now after more than 200 lap appendectomies I realise that it is more simple procedure technically (for me) and the easiest operations last 15 min and the patients recover ealier.

Therefore whatever the studies claim, my opinion is that laparoscopic appendectomy is better procedure in experienced hands.