Laparoscopic cholecystectomy in pregnancy
- 41 Downloads
Background: Laparoscopic cholecystectomy is now the standard treatment for symptomatic gallstones; while symptomatic gallstones during pregnancy are not frequent they are by no means rare. The role of laparoscopic cholecystectomy during pregnancy is controversial but initial reports suggest it is both safe and feasible.
Methods: During a consecutive series of 500 laparoscopic cholecystectomies, 3 patients have undergone laparoscopic cholecystectomy during pregnancy. The 3 patients were 16–27 weeks pregnant with an average age of 32 years. The indication for laparoscopic cholecystectomy was severe pain in two patients and gallstone pancreatitis in one patient. Following standard obstetric anesthesia, laparoscopic cholecystectomy was performed. Open cannulation was used to establish peritoneal access, following which “standard,” four-port laparoscopic cholecystectomy was performed without complication. The insufflation pressure used was 8–10 mmHg CO2 and a liver retractor was employed to facilitate access.
Results: In each case the postoperative recovery was rapid and uneventful for both mother and fetus. The patients were discharged on the first or second postoperative day.
Conclusions: Laparoscopic cholecystectomy during the second trimester of pregnancy is both safe and feasible provided both suitable surgical and anesthetic expertise are available. Even up to the end of the second trimester there is sufficient access for the technique to be employed.
Key wordsLaparoscopic cholecystectomy Pregnancy Second-trimester pregnancy
Unable to display preview. Download preview PDF.
- 1.Adamsen S, Jacobsen B, Bentzon N (1993) Laparoskopisk kolecystektomi under graviditet. Ugeskr Laeger 155: 2215–2216Google Scholar
- 2.Arvidsson D, Gerdin E (1991) Laparoscopic cholecystectomy during pregnancy. Surg Laparosc Endosc 1: 193–194Google Scholar
- 3.Bennett TL, Estes N (1993) Laparoscopic cholecystectomy in the second trimester of pregnancy. A case report. J Reprod Med 38: 833–834Google Scholar
- 4.Chandra M, Shapiro SJ, Gordon LA (1994) Laparoscopic cholecystectomy in the first trimester of pregnancy. Surg Laparosc Endosc 4: 68–69Google Scholar
- 5.Comitalo JB, Lynch D (1994) Laparoscopic cholecystectomy in the pregnant patient. Surg Laparosc Endosc 4: 268–271Google Scholar
- 6.Constantino GN, Vincent GJ, Mukalian GG, Klieforth WL (1993) Laparoscopic cholecystectomy in pregnancy. J Laparoendosc Surg 3: 291–293Google Scholar
- 7.Csaba J, Orban I (1994) Laparoscopos cholecystectomia 25 hetes terhessegben. Orv Hetil 135: 1421–1422Google Scholar
- 8.Edelman DS (1994) Alternative laparoscopic technique for cholecystectomy during pregnancy. Surg Endosc 8: 794–796Google Scholar
- 9.Elerding SC (1993) Laparoscopic cholecystectomy in pregnancy. Am J Surg 165: 625–627Google Scholar
- 10.Fabiani P, Bongain A, Persch M, Beniziri E, Mouiel J, Gillet JY (1993) Chirurgie percoelioscopique pendnant la grossesse. Un cas de cholecystectomie. J Gynecol Obstet Biol Reprod 22: 317–319Google Scholar
- 11.Hart RO, Tamadon A, Fitzgibbons RJ, Fleming A (1993) Open laparoscopic cholecystectomy in pregnancy. Surg Laparosc Endosc 3: 13–16Google Scholar
- 12.Holohan TV (1991) Laparoscopic cholecystectomy. Lancet 338: 801–803Google Scholar
- 13.Hunter JG, Swanstrom L, Thornburg K (1995) Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model. Surg Endosc 9: 272–279Google Scholar
- 14.Jackson SJ, Sigman HH (1993) Laparoscopic cholecystectomy in pregnancy. J Laparoendosc Surg 3: 35–39Google Scholar
- 15.Liu SY, Leighton T, Davis I, Klein S, Lippmann M, Bongard F (1991) Prospective analysis of cardiopulmonary responses to laparoscopic cholecystectomy. J Laparoendosc Surg 1: 241–246Google Scholar
- 16.Martin IG, Holdsworth PJ, Asker J, Baltas B, Glinatsis MT, Sue-Ling H, Gibson J, Johnston D, McMahon MJ (1992) Laparoscopic cholecystectomy as a routine procedure for gallstones: results of an “allcomers” policy. Br J Surg 79: 807–810Google Scholar
- 17.Morrel DG, Mullins JR, Harrison PB (1992) Laparoscopic cholecystectomy during pregnancy in symptomatic patients. Surgery 112: 856–859Google Scholar
- 18.Pucci RO, Seed RW (1991) Case report of laparoscopic cholecystectomy in the third trimester of pregnancy. Am J Obstet Gynecol 165: 401–402Google Scholar
- 19.Rusher AH, Fields B, Henson K (1993). Laparoscopic cholecystectomy in pregnancy: contraindicated or indicated? J Ark Med Soc 89: 383–384Google Scholar
- 20.Shaked G, Twena M, Charuzi I (1994) Laparoscopic cholecystectomy for emyema of the gallbladder during pregnancy. Surg Laparosc Endosc 4: 65–67Google Scholar
- 21.Soper NJ, Hunter JG, Petrie RH (1992) Laparoscopic cholecystectomy during pregnancy. Surg Endosc 6: 155–157Google Scholar
- 22.Stephan F, Bloquel R (1968) Effets teratogenes d'une interruption temporaire des echanges respiratories chez l'embryon de poulet. C R Seances Soc Biol Fil 162 (12): 2242–2244Google Scholar
- 23.Weber AM, Bloom GP, Allan TR, Curry SL (1991) Laparoscopic cholecystectomy in pregnancy. Obstet Gynecol 78: 958–959Google Scholar
- 24.Wilson RB, McKenzie RJ, Fisher JW (1994) Laparoscopic cholecystectomy in pregnancy: two case reports. Aust N Z J Surg 64: 647–649Google Scholar