, Volume 25, Issue 11, pp 3477-3478
Date: 22 Sep 2011

SAGES’ guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy

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Since the introduction of laparoscopic cholecystectomy in the late 1980s surgeons have experienced much angst when confronted with a pregnant woman requiring operative treatment. Should surgical intervention be entertained? Is laparoscopy under these circumstances safe? If laparoscopy is contemplated, during which trimester can it be performed most safely? Should intraoperative fetal monitoring be performed? Should tocolytics be employed routinely?

In the early 1990s several studies using a pregnant ewe model demonstrated fetal acidosis accompanying a CO2 pneumoperitoneum [1], increasing surgeons’ anxiety about using laparoscopy at all during pregnancy. Ultimately, most surgeons developed a conservative approach. The accepted wisdom was that surgery, including laparoscopy, was best done in the second trimester, avoiding the period of maximal organogenesis in the first trimester and the risk of premature labor in the third trimester [2]. Many patients with symptomatic cholelithiasis were ...