Laparoscopic bile duct exploration during pregnancy: a multi-center case series and literature review

Abstract

BackgroundThe physiological changes of pregnancy increase the risk of gallstone formation and choledocholithiasis. Traditionally, endoscopic retrograde cholangiopancreatography (ERCP) has been the main approach for managing choledocholithiasis during pregnancy, but recent progress in laparoscopic bile duct exploration (LBDE) has demonstrated this technique as a safe and effective alternative option. MethodsA retrospective multicenter study of all patients who underwent LBDE during pregnancy from ve centers with proven experience in LBDE between January 2010 and June 2020 was performed. The primary endpoint was to analyze the role of LBDE during pregnancy and to further characterize its position as a safe and effective alternative for the management of choledocholithiasis. A systematic review of the published literature relating to LBDE during pregnancy until February 2022 was also performed. ResultsFive from 17 centers, with a total of 3950 LBDEs reported performing LBDE during pregnancy with a cumulative experience of eight patients (0.2%). Median surgical time was 75 minutes (range: 60-140 minutes). The bile duct was cleared successfully in all patients and the median hospital stay was 2 days (range:1-3 days). The literature review identi ed a total of seven patients with a successful CBD clearance rate of 86%. There were no major maternal, fetal or pregnancy-related complications in any of the total 15 patients included. ConclusionThe limited available data suggests that LBDE during pregnancy is a safe and effective. More evidence reporting outcomes of LBDE during pregnancy is needed before any strong recommendations can be made.

SAGES guidelines for the use of laparoscopy during pregnancy

“…The existing literature on CBDE during pregnancy is primarily comprised of individual case reports and was therefore excluded from our literature search. In 2023, Lopez-Lopez et al published a multi-center case series of 8 patients [ 90 ]. They reported two low-grade bile leaks managed without intervention but otherwise attributed no postoperative complications for mother or fetus to CBDE.…”

Laparoscopic Surgery During Pregnancy: A Meta-Review and Quality Analysis Using the Assessment of Multiple Systematic Reviews (AMSTAR) 2 Instrument

“…Based on their discipline, the studies were classified as follows, in descending order: LA 10 studies (30.3%) [ 13 , 14 , 31 - 38 ], laparoscopic cerclage for cervical insufficiency eight studies (24.2%) [ 15 - 19 , 39 - 41 ], adnexal-ovarian laparoscopic surgery five studies (15.2%) [ 20 , 21 , 42 - 44 ], laparoscopic cholecystectomy and biliary tree exploration three studies (9.1%) [ 22 , 23 , 45 ], laparoscopic myomectomy two studies (6.1%) [ 24 , 25 ], and one each for laparoscopic surgery regarding pancreatic indications [ 28 ], adrenal indications [ 26 ], and bariatric complications (3.0%) [ 27 ]. Two studies were interdisciplinary, one examining robotic-assisted laparoscopic surgery during pregnancy for any indication [ 29 ], and one investigating non-obstetric surgery during pregnancy in general [ 30 ].…”

“…Laparoscopic cholecystectomy & bile duct exploration: This category included one meta-analysis comparing laparoscopic cholecystectomy (LC) versus open cholecystectomy during pregnancy [ 45 ], one SR on LC [ 23 ], and one SR on laparoscopic bile duct exploration (LBDE) during pregnancy [ 22 ]. The MA found a cumulative OR of 0.39 (95%CI 0.07-2.19) regarding fetal loss, whereas the respective figures were a non-significant 1.35 (95%CI 0.41-5.14) for preterm delivery, a significant 0.45 (95%CI 0.25-0.82) for perioperative complications, and a non-significant 3.88 (95%CI 0.15-100.23) for maternal mortality [ 45 ].…”

“…The SR on LC retrieved 590 relevant cases, with a fetal loss rate of 0.4%, a preterm delivery rate of 5.7%, and a postoperative complication rate of 4% [ 23 ]. Finally, the literature review on LBDE identified 15 cases (among which seven had been published in the past), with a success rate of the procedure reaching 86%, without major fetal or maternal complications [ 22 ].…”