Laparoscopic Cholecystectomy During Pregnancy

Abstract

This study was conducted to evaluate the role of antepartum laparoscopic cholecystectomy (LC). Patients who underwent LC were identified from a hospital database with the use of CPT/ICD codes. Of 2093 cases performed at a major center (October 1991 to November 1997), only six were performed during pregnancy. On reviewing the English literature, gestational age at surgery and delivery and outcome of delivery were provided in only 69 of 105 patients (33 papers with 1-10 cases) and we tabulated different variables from the cases in this review. In this series, two patients who had LC in the first trimester underwent elective termination of pregnancy. Of the seven published cases of first trimester LC followed to delivery, one had preterm delivery. First trimester open cholecystectomy (OC) has a 12 percent spontaneous abortion rate. The four patients who had second trimester LC had normal deliveries at term. Of the 43 published cases of second trimester LC followed to delivery, 39 ended in uncomplicated, full-term deliveries. Three of four second trimester cases at one institution had spontaneous abortions. None of our patients underwent LC in the third trimester. Of the 12 published cases of third trimester LC followed to delivery, one had preterm delivery. Third trimester OC is reported to have a 40 percent rate of preterm delivery. There were no intraoperative cholangiograms (IOC), prophylactic or postoperative use of tocolytics, or intraoperative fetal monitoring in our series. We added six cases of LC during pregnancy to the previously reported 105 cases. The successful outcome in all trimesters suggests that LC is a safe procedure throughout pregnancy; however, surgery in the second trimester is preferable. Compared with OC, there is a decreased risk of spontaneous abortion in the first trimester and preterm labor in the third trimester.

The course and outcomes of complicated gallstone disease in pregnancy: Experience of a tertiary center

“…The management of symptomatic biliary disease during pregnancy has often been nonsurgical to avoid fetal and maternal harm ( 10 ) , but ironically, this results in a high rate of antepartum symptom recurrence ( 2 , 8 , 9 ) . Although laparoscopy is known to be safe in the second trimester, studies have reported the risk of preterm labor or spontaneous abortion with LC ( 12 , 13 ) .…”

“…Recent guidelines recommended LC during pregnancy for all symptomatic gallstone disease ( 8 , 9 ) and laparoscopic treatment of acute abdominal disease has the same indications in pregnant and non-pregnant patients ( 18 ) . Studies reporting uterine injury during trocar placement, increased risk of preterm labor and spontaneous abortion with LC exist, even though they were performed in the second trimester ( 12 , 13 ) . The rate of preterm labor is 0-20% for LC ( 19 , 20 , 21 , 22 , 23 ) .…”

Ovarian cyst impacted in the pouch of Douglas at 20 weeks' gestation managed by laparoscopic ovarian cystectomy: a case report

“…Generally, open cannulation laparoscopy or Palmer's point entry is recommended for laparoscopy during pregnancy. This avoids the risk of penetrating injury to the pregnant uterus by either the Verres needle or the trocar cannula [13]. …”

Laparoscopic cholecystectomy during pregnancy: A case series

“…Conversion rates are from 1.8 to 7.8%. [28] Specific complications include hemorrhage, bile leaks, retained stones, wound infections and incisional hernias. [928–29]…”

“…The key points associated with higher success rate in laparoscopic cholecystectomy during pregnancy: Experienced surgeon[28]Trendelberg and left tilted position[20–22]Insertion of the first trocar with great precussion especially in late pregnancy to avoid injury of gravid uterus[18]Pneumoperitoneum created with an average intraabdominal pressure of 10–12 mmHg[23]Adequate Mother monitoring (adequate management of anesthetic, adequate hydration of mother to reduce the likelihood of premature labor) and treating the contractions with tocolytics. [4]…”