Meta‐analysis comparing the safety of laparoscopic and open surgical approaches for suspected adnexal mass during the second trimester

BACKGROUND: The safety of laparoscopic surgery during the second trimester of pregnancy remains a controversial subject. OBJECTIVES: To compare the safety of laparoscopic surgery and laparotomy for suspected adnexal mass during the second trimester. SEARCH STRATEGY: Articles published in any language prior to April 31, 2016, were retrieved from PubMed, Scopus, EMBSCO, and the Cochrane Library using keywords including pregnant, adnexal mass, laparoscopy, laparotomy, pregnancy outcomes, and surgical outcomes. SELECTION CRITERIA: Randomized and non-randomized controlled trials reporting at least one obstetric or surgical outcome were included if they compared laparoscopic surgery and laparotomy for adnexal masses during the second trimester. DATA COLLECTION AND ANALYSIS: Data were independently extracted by two reviewers. Homogeneous data were pooled using a fixed effects model and heterogeneous data were qualitatively analyzed. MAIN RESULTS: Four comparative effectiveness studies including a total of 240 patients were identified. Laparoscopic surgery was associated with a reduced risk of post-operative adverse events (relative risk 0.20, 95% confidence interval 0.06-0.72); no difference was recorded in the risk of post-operative spontaneous abortion (P=0.26) or threatened spontaneous abortion (P=0.13). CONCLUSIONS: Laparoscopic surgery could be preferable to laparotomy for suspected adnexal mass during the second trimester of pregnancy.