Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review

Abstract

Treatment of surgical disease in the gravid patient requires a unique and careful approach where safety of the mother and fetus are both considered. Approaches to diagnosis and therapy of surgical disease in the gravid patient are increasingly clarified and defined in the literature. Laparoscopy, once described as contraindicated in pregnancy, has been steadily accepted and applied as data supporting its safety and use have accumulated. An extensive review of the literature was performed to define the use of laparoscopy in pregnancy. Diagnoses for independent surgical diseases as well as imaging modalities and techniques during pregnancy are reviewed. Preoperative, intraoperative, and postoperative management of the pregnant patient are described and evaluated with focus on use of laparoscopy. Literature supporting safety and efficacy of laparoscopy in cholecystectomy, appendectomy, solid organ resection, and oophorectomy in the gravid patient is outlined. Based on level of evidence, this review includes recommendations specific to surgical approach, trimester of pregnancy, patient positioning, port placement, insufflation pressure, monitoring, venous thromboembolic prophylaxis, obstetric consultation, and use of tocolytics in the pregnant patient.

Laparoscopic appendectomy during pregnancy: an evidence-based review

“…We agree with Jackson et al [1], that an evidence-based approach to surgical intervention in pregnancy should be our aim. This is limited in the case of laparoscopic appendectomy, as currently there is no level I evidence to guide management of acute appendicitis in pregnant women.…”

“…Dear Editor, We commend Jackson et al for an interesting review of the role of laparoscopic surgery for surgical diseases during pregnancy [1]. They note that, in pregnancy, ''laparoscopic appendectomy is considered by many to be the standard of care''.…”

Management of Acute Appendicitis in Pregnancy

“…The mean age of the patients was 26 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) years. The mean gestational age at the time of LA was 17.6 weeks (4-33 weeks).…”

“…[29][30][31] We operated 10 patients within 12 hours with laparoscopic approach. We used open technique for the first trocar insertion.…”

Laparoscopic Surgery in Luminal Gastrointestinal Emergencies—a Review of Current Status

“…Laparoscopy has been found to be safe in any trimester [18], but LA was associated with longer operating time and higher conversion rates in the third trimester [17].…”