Laparoscopy in pregnancy treats ovarian masses. (Less Postoperative Pain than Laparotomy).

SAN FRANCISCO -- Two separate studies favored laparoscopy over laparotomy for surgical treatment of ovarian masses during pregnancy, investigators reported at the annual meeting of the American Association of Gynecologic Laparoscopists.

In general, laparoscopy produces less postoperative pain and a lower risk of infection, compared with laparotomy. Laparoscopy, however, raises concerns about other problems, such as the effects of longer surgeries, potential trauma to the fetus, and compromise of uteroplacental blood flow.

In addition, data are just beginning to accumulate on the use of laparoscopy in pregnancy. "There are very few people in the world who have a lot of experience with this," commented Dr. William H. Parker of Santa Monica, Calif., a session moderator at the meeting.

In the first study, researchers analyzed data on 378 women who underwent a total of 389 surgeries using either laparotomy (192 cases) or laparoscopy (197 cases). Some women had more than one operation per pregnancy.

Most surgeries were done to treat adnexal masses (264 cases) or appendicitis (105 cases). The mean age of patients, parity, and operating times were similar between the laparoscopy and laparotomy groups.

Women in the laparoscopy group were discharged from the hospital sooner--in 3 days rather than 44--as might be expected. Significantly more complications occurred in the laparotomy group, compared with the laparoscopy group (26 vs. 6). The complications included more fevers and premature contractions and two cases of pulmonary emboli in the laparotomy group, compared with no pulmonary emboli in the laparoscopy group, reported Dr. Gabriel Oelsner of Kiryat Ono, Israel.

There were no differences between groups in spontaneous abortion rates in either the first or second trimester. No significant differences between groups were found in rates of preterm deliveries, low-birth-weight babies, or fetal anomalies.