Laparoscopic surgery for symptomatic cholelithiasis during pregnancy

Abstract

Introduction: We are introducing here additional evidence regarding efficacy and safety of laparoscopic cholecystectomy during pregnancy. This is achieved by analysis of 10 successful cases of symptomatic cholelithiasis operated laparoscopically during pregnancy.

Purpose: To prove the fact that laparoscopic cholecystectomy is safe and effective during pregnancy, especially in the first trimester.

Background: Cholecystectomy represents the second most common nonobstetric operation during pregnancy. The laparoscopic management of symptomatic cholelithiasis during pregnancy is becoming the standard of care at our center king Abdullah university hospital (KAUH). Old restrictions on this treatment modality are changing; open surgery is not considered to be the only choice any more.

Methods: Ten laparoscopic cholecystectomies during pregnancy at variable gestational ages performed between February 2002 and June 2006 are reported here, all at KAUH. Their medical records were reviewed, deliveries were followed up, outcomes were analyzed, and results were compared with literature.

Results: Five patients were in their first trimester; 3 were in their second trimester and 2 in their third trimester in my series. Open cholecystectomy was not used at all in these patients. Intraoperative cholangiography was not performed. No tocolytic agents were given. No maternal or fetal mortality have been reported. None of fetuses had anomalies. One patient who refused any surgical intervention presented with repeated attacks of biliary colic at gestational age of 26 weeks; this pregnancy ended up with stillbirth at 33 weeks.

Conclusions: In my series, laparoscopic cholecystectomy was safe through out all stages of pregnancy. When undertaken by skilled laparoscopic surgeon, it carries low mortality and morbidity. We highlight the fact that first trimester symptomatic cholelithiasis can be managed safely by laparoscope. We add to the evidence that laparoscopic cholecystectomy may not interfere with organogenesis. Early uterine contractions were not reported, though, we think that prophylactic tocolytics are not indicated unless uterine contractions are confirmed. Certain positioning styles, and cannulation techniques, are part of major guidelines that we recommend to be followed during this surgery.