Laparoscopic Procedures in Pregnancy

Abstract

As the applications of laparoscopy for general surgical procedures expanded in the 1990s, pregnancy was initially considered a contraindication. Several case reports have suggested the safety of laparoscopy in pregnancy. Previous clinical studies indicate a higher fetal mortality may exist and advised caution. To evaluate the fetal outcome of laparoscopic procedures in pregnant patients at our institution, we retrospectively reviewed the medical records between 1991 and 1997 and identified 21 pregnant patients who underwent either a laparoscopic (n = 12) or open (n = 9) procedure. Appendectomies, cholecystectomies, and diagnostic laparoscopics were performed. Specific variables including age, length of procedure, hospital stay, duration of parenteral analgesic use, gestational age at the time of surgery and delivery, O2 saturation and EtCO2 during surgery, APGAR scores, and birth weights were compared between the two groups. Laparoscopic procedures during pregnancy resulted in shorter hospital stays (34 hours versus 91 hours; P = 0.01), less use of parenteral narcotic analgesics (5 hours versus 29 hours; P = 0.05), and no prolongation of operative times (51 minutes versus 63 minutes; P = 0.20). In addition, laparoscopy was performed at earlier gestational ages (12 weeks versus 29 weeks; P = 0.001). There was one miscarriage 7 days after a laparoscopic cholecystectomy early in the 1st trimester that was not statistically significant. Our experience did not show a higher incidence of fetal loss when comparing laparoscopic to open procedures in pregnant patients.

Risk Factors and Risk Stratification for Adverse Obstetrical Outcomes After Appendectomy or Cholecystectomy During Pregnancy

“…Of the 10 risk factors identified, 4 were previously reported as increasing the risk for obstetric complications after appendectomy or cholecystectomy during pregnancy: open procedures conferred significantly more risk than laparoscopic procedures, [10][11][12][13][14][15][16] the presence of systemic infection (sepsis or peritonitis) was associated with increased morbidity compared with local infection, 2,5,10 and Medicaid beneficiaries have been shown to have an increased risk of adverse outcomes. 3 To our knowledge, this is the first study to investigate and conclude that obstetrical conditions (cervical incompetence [AOR, 24.29; 95% CI, 7.48-78.81], preterm labor during current pregnancy [AOR, 18.34; 95% CI, 4.95-67.96], and vaginitis or vulvovaginitis [AOR, 5.17; 95% CI, 2.19-12.23]), rather than maternal-, surgery-, or disease-associated variables, have the strongest association with adverse obstetric outcomes after appendectomy or cholecystectomy.…”

“…Of the 10 risk factors identified, 4 were previously reported as increasing the risk for obstetric complications after appendectomy or cholecystectomy during pregnancy: open procedures conferred significantly more risk than laparoscopic procedures, the presence of systemic infection (sepsis or peritonitis) was associated with increased morbidity compared with local infection, and Medicaid beneficiaries have been shown to have an increased risk of adverse outcomes …”