DIFFERENTIAL SURGICAL TACTICS IN ACUTE APPENDICITIS AT DIFFERENT PREGNANCY TERMS
Aim. To optimize the diagnosis and treatment of acute appendicitis at different terms of pregnancy. Material and methods. Clinical material included the results of diagnosis and treatment of 154 pregnant women admitted to surgical and delivery units of City Clinical Hospital №8 with diagnosis of acute appendicitis against the background of pregnancy. Results. Sixty seven (63,2 %) pregnant women of the main group had clinicolaboratory picture corresponding to acute appendicitis. When comparing the clinicolaboratory data with the scoring system Alvarado Score for Acute Appendicitis, diagnosis was stated in 57 (53,8 %) pregnant women ( p < 0,05). In the main group, 34 women underwent appendectomy using traditional Volkovich-Dyakonov approach, 3 women - pararectal Lenander approach; in 8 cases laparoscopic appendectomy was performed, in 4 cases - laparascopically supplemented appendectomy. In the control group, 22 (68,8 %) patients experienced appendectomy using Volkovich-Dyakonov approach, 10 - midline laparotomy. Conclusions. To diagnose acute appendicitis in pregnant women, it is expedient to use Alvarado scoring system. In pregnancy trimester I (up to 12 weeks), it is desirable to use oblique incision by Volkovich-Dyakonov or laparoscopic appendectomy. In pregnancy trimester II, it is necessary to use pararectal Lenander approach appendectomy or wide approach by Volkovich-Dyakonov (not less than 8-9 cm), For the purpose of reducing negative effect of pneumoperitoneum of laparoscopic interventions, it is expedient to use laparoscopically assisted interventions.