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Step towards better healthcare: Laparoscopic appendectomy for pregnant women starts at PIMS

By Jamila Achakzai

ISLAMABAD: After using conventional methods to remove appendix from pregnant women with acute appendicitis for many years, Pakistan Institute of Medical Sciences (PIMS) surgeons have begun performing laparoscopic appendectomy during pregnancy.

In Pakistan, only one or two surgeons and that too in Karachi currently perform laparoscopic surgery on expectant women although it’s now an established procedure in the developed world, Assistant Professor of PIMS General Surgery Department Dr Atif Inam told Daily Times on Friday.

Dr Inam, who specialises in laparoscopic hernia repair and colorectal surgery, said appendectomy was a common emergency operative procedure for acute appendicitis and could be done laparoscopically with much ease. He said appendicitis – a painful swelling of the appendix that can be very serious – could affect human beings of all ages and its incidence in pregnancy was one in 50,000 to 65,000 pregnancies.

He said if untreated or late surgical intervention during pregnancy, the peritoneal inflammation it caused could lead to complications like high risk of foetal death and even maternal death.

He said the risk of abortion after surgery for appendicitis used to be high but improvement in anesthesia and obstetric care had reduced the risk significantly.

He said appendectomy if performed timely during pregnancy was a safe procedure and could save the life of mother and coming baby.

Dr Inam said the advantage of laparoscopic or minimal invasive surgery was less postoperative pain, early recovery, decreased wound infection and better cosmesis. He said recently, he successfully performed laparoscopic appendectomy on a 23-week pregnant woman.

According to the laparoscopic surgeon, the woman was operated upon on September 9 and was discharged the day after with no signs of foetal complications. She had a speedy recuperation without any complications. He said the surgical procedure was the first of its kind in the history of PIMS. Dr Inam declared laparoscopic appendectomy during pregnancy a challenging procedure requiring high-level of expertise by the surgeon.

“This is because surgical access is difficult due to enlarged uterus leading into tight packing of the intestines in the abdomen. All this results into reduced working space for the surgeon,” he said. He said the advantages of the laparoscopic surgery when performed by an expert was diagnostic accuracy, less operative injury (markedly reduced incision length), less pain, better cosmesis, shortened operative time, decreased wound infection and early recovery compared with conventional open surgery.

He said laparoscopic appendectomy during pregnancy, especially in second trimester – one of the three three-month periods into which human pregnancy is divided – was superior to conventional open surgery. He felt the PIMS surgeons could perform advanced laparoscopic operations on a par with the developed countries provided they were supported by the government because advanced laparoscopic surgical procedures required specialised training and technically advanced equipment.

Dr Inam said he trained young surgeons on laparoscopic surgery. “I hold weekly interactive tutorials with video presentations in laparoscopic surgery for surgical residents and has developed a dry lab facility for laparoscopic training of postgraduate trainees in the surgical ward,” he said. The PIMS assistant director also said he was working on a project to establish online video library of the operations performed at PIMS.

The library will be accessible to young surgeons and people concerned, he said.

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