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Pregnancy and abdominal surgery

Surgery linked to risk of abdominal surgery during pregnancy

During the first pregnancy after bariatric surgery, the rate of surgery for intestinal obstruction was 1.5% in women in the case group compared with 0.02% among women in the control group

Bariatric surgery is associated with an increased risk of abdominal surgery during subsequent pregnancy, according to a study published in the Obstetrics & Gynecology. Researchers from Central Hospital in Helsingborg and Lund University, Lund, Sweden, To compare the rates of abdominal surgery during pregnancy among women with previous bariatric surgery (women in the case group) and women with first-trimester BMI>35 and no previous bariatric surgery (women in the control group).

Study authors, Drs Andrea Stuart (Helsingborg) and Karin Källen (Lund) analysed data from the Swedish Medical Birth Registry and the Swedish National Patient Registry. The primary outcome variables were diagnosis and surgical procedure codes grouped as five outcome categories: 1) intestinal obstruction, 2) gallbladder disease, 3) appendicitis, 4) hernia, and 5) diagnostic laparoscopy or laparotomy without the presence of a diagnosis or surgical code for outcomes in outcome categories 1–4.

Odds ratios were computed using multivariate linear regression analysis for each separate pregnancy. For all pregnancies in a given woman, general estimating equations with robust variance estimation were used. Adjustment was made for smoking, year of delivery, maternal age, and previous abdominal surgery.

The paper, ‘Risk of Abdominal Surgery in Pregnancy Among Women Who Have Undergone Bariatric Surgery’, reported that during the first pregnancy after bariatric surgery, the rate of surgery for intestinal obstruction was 1.5% (39/2,543; 95% confidence interval [CI] 1.1–2.0%) in women in the case group compared with 0.02% (4/21,909; 95% CI 0.0–0.04%) among women in the control group (adjusted odds ratio [OR] 34.3, 95% CI 11.9–98.7).

Similarly, the rate of diagnostic laparoscopy or laparotomy was 1.5% (37/2,542; 95% CI 1.0–1.9%) among women in the case group compared with 0.1% (18/21,909; 95% CI 0.0–0.1%) among women in the control group (adjusted OR 11.3, 95% CI 6.9–18.5).

"Bariatric surgery is associated with an increased risk of abdominal surgery during pregnancy," the authors write. "Although the absolute risk of abdominal surgery is small, it must nevertheless be weighed against the reduction of obesity-related obstetric risk factors after bariatric surgery when advising obese women about family planning." 

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