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Adamina M, Andreou A, Arezzo A, Christogiannis C, Di Lorenzo N, Gioumidou M, Glavind J, Iavazzo C, Mavridis D, Muysoms FE, Preda D, Smart NJ, Syropoulou A, Tzanis AΑ, Van de Velde M, Vermeulen J, Antoniou SA. EAES rapid guideline: systematic review, meta-analysis, GRADE assessment, and evidence-informed European recommendations on appendicitis in pregnancy. Surg Endosc 2022; 36:8699-8712. [PMID: 36307599 DOI: 10.1007/s00464-022-09625-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Clinical practice recommendations for the management of acute appendicitis in pregnancy are lacking. OBJECTIVE To develop an evidence-informed, trustworthy guideline on the management of appendicitis in pregnancy. We aimed to address the questions of conservative or surgical management, and laparoscopic or open surgery for acute appendicitis. METHODS We performed a systematic review, meta-analysis, and evidence appraisal using the GRADE methodology. A European, multidisciplinary panel of surgeons, obstetricians/gynecologists, a midwife, and 3 patient representatives reached consensus through an evidence-to-decision framework and a Delphi process to formulate the recommendations. The project was developed in an online authoring and publication platform (MAGICapp). RESULTS Research evidence was of very low certainty. We recommend operative treatment over conservative management in pregnant patients with complicated appendicitis or appendicolith on imaging studies (strong recommendation). We suggest operative treatment over conservative management in pregnant patients with uncomplicated appendicitis and no appendicolith on imaging studies (weak recommendation). We suggest laparoscopic appendectomy in patients with acute appendicitis until the 20th week of gestation, or when the fundus of the uterus is below the level of the umbilicus; and laparoscopic or open appendectomy in patients with acute appendicitis beyond the 20th week of gestation, or when the fundus of the uterus is above the level of the umbilicus, depending on the preference and expertise of the surgeon. CONCLUSION Through a structured, evidence-informed approach, an interdisciplinary panel provides a strong recommendation to perform appendectomy for complicated appendicitis or appendicolith, and laparoscopic or open appendectomy beyond the 20th week, based on the surgeon's preference and expertise. GUIDELINE REGISTRATION NUMBER IPGRP-2022CN210.
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Affiliation(s)
- Michel Adamina
- Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
| | - Anthoula Andreou
- Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Christos Christogiannis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Nicola Di Lorenzo
- Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy
| | - Meropi Gioumidou
- Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
| | - Julie Glavind
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Christos Iavazzo
- Gynaecological Oncology Department, Metaxa Cancer Hospital, Piraeus, Greece
| | - Dimitrios Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
- Faculté de Médecine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Filip E Muysoms
- Department of Surgery, Maria Middelares Hospital, Gent, Belgium
| | - Daniel Preda
- 1St Clinic of Surgery, Craiova Emergency Clinical County Hospital, Craiova, Romania
| | - Neil J Smart
- Department of General Surgery, Royal Devon and Exeter Hospital, Exeter, UK
| | | | | | - Marc Van de Velde
- Department of Cardiovascular Sciences, KU Leuven and Department of Anaesthesiology, UZ Leuven, Louvain, Belgium
| | - Joeri Vermeulen
- Department Health Care, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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