Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy

Objective: To compare the outcome of pregnancy after operative laparoscopy or laparotomy for the management of adnexal pathology during pregnancy. Design: Retrospective comparative study. Setting: University tertiary care referral center for endoscopic surgery. Patient(s): Eighty- eight pregnant women who underwent 93 operations for suspected adnexal pathology at our institute. Laparoscopy was performed during the first trimester in 39 patients. The remaining 54 patients underwent laparotomy, 25 during the first trimester and 29 during the second trimester. Intervention(s): Laparoscopy or laparotomy for the management of adnexal masses during pregnancy. Main Outcome Measure(s): Operative and postoperative maternal complications, miscarriage, congenital malformations, and newborn long-term outcome. Result(s): No operative or postoperative maternal complications occurred in the pregnant women who underwent laparoscopic surgery. In this group of 39 women, 5 women had a first-trimester miscarriage and 2 newborns had congenital malformations (hypospadias and cleft lip and palate). Two miscarriages occurred in the first-trimester laparotomy group, and 1 congenital malformation (transposition of the great vessels) was diagnosed in the second-trimester laparotomy group. Conclusion(s): Laparoscopic gynecologic surgery appears to be safe during pregnancy, although prospective controlled studies and national registries encompassing larger numbers of cases are needed.