Laparoscopic cholecystectomy during pregnancy is safe for both mother and fetus

Abstract

The use of laparoscopic cholecystectomy in pregnant women has been slow to gain wide acceptance for two reasons: one is the potential for mechanical problems related to the pregnant uterus and the other is fear of fetal injury resulting from instrumentation or the pneumoperitoneum. To assess the effects of laparoscopic cholecystectomy on both the mother and the unborn fetus, we reviewed our surgical experience over a 5-year period analyzing indications for the procedure along with complications and outcome. During this 5-year period, 22 patients ranging in age from 17 to 31 years underwent laparoscopic cholecystectomy during pregnancy. Gestational ages ranged from 5 to 31 weeks with two patients being in the first trimester, 16 in the second, and four in the third. The primary indications for surgical intervention were persistent nausea, vomiting, pain, and inability to eat in 17 patients, acute cholecystitis in three, and choledocholithiasis in two. In all patients a pneumoperitoneum was established by means of a closed technique starting in the right upper quadrant of the abdomen. Two of the 22 patients also underwent successful transcystic common bile duct exploration with removal of common duct stones. All 22 patients survived the surgical procedure without complications, and there were no fetal deaths or premature births related to the procedure. Based on the preceding results, it would appear that laparoscopic cholecystectomy during pregnancy is safe for both the mother and the unborn fetus. Indications for this procedure should include stringent criteria such as unrelenting biliary tract symptoms or the complications of cholelithiasis. If at all possible, when laparoscopic cholecystectomy is indicated, it should be performed either in the second trimester or early in the third.

Laparoscopic appendectomy and cholecystectomy versus open: a study in 1999 pregnant patients

“…Unfortunately, fetal outcomes were not captured within the NSQIP database. The use of laparoscopy throughout all trimesters has not always been widely accepted [12][13][14], but in numerous [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The first described case of laparoscopic appendectomy was performed during the 8th week of pregnancy, followed thereafter with a 1990 case series of six patients averaging 16.3 weeks of gestation; each had no reported complications.…”

Safety and Timing of Nonobstetric Abdominal Surgery in Pregnancy

“…No large prospective human trials evaluating the safety of laparoscopic surgery during pregnancy have been published. However, several reports of laparoscopic cholecystectomy during pregnancy summarizing over 150 cases have shown no adverse effects on fetal outcome [5, 6, 7, 8, 38, 39]. Only a single widely quoted series reported poor outcomes, with fetal loss occurring in 4 of 7 cases [9].…”

“…Limited animal data suggest that pneumoperitoneum may induce fetal acidosis and tachycardia [4]. While several reports of laparoscopic cholecystectomy have shown no adverse effects on fetal outcome [5, 6, 7, 8], others have described a high rate of fetal loss [9]. The advisability of laparoscopic surgery during pregnancy therefore remains uncertain.…”

Changing management of gallstone disease during pregnancy

“…However, laparoscopic techniques have been safely utilized in pregnant patients since the early 1970s for the management of obstetrical disease. In recent years, anecdotal reports summarizing over 100 cases of laparoscopic cholecystectomy during pregnancy have largely shown no adverse effects [1,8]. Only one small series has reported bad outcomes, with fetal loss occurring in four of seven patients [2].…”

“…Limited animal data suggests that pneumoperitoneum may induce fetal acidosis and tachycardia [5]. No [1,3,8,10,12]. Other series, however, describe a high fetal loss rate [2].…”