Skip to main content
Log in

Laparoscopic versus open cholecystectomy in pregnancy: a systematic review and meta-analysis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript



The operative management of symptomatic cholelithiasis during pregnancy is either laparoscopic cholecystectomy (LC) or open cholecystectomy (OC). The aim of this systematic review and meta-analysis is to compare the outcomes of the laparoscopic and open approach for cholecystectomy during pregnancy.


A literature search was conducted using MEDLINE, PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL and Current Contents Connect using appropriate search terms. All comparative studies reporting maternal, fetal, and/or surgical complications were included.


Eleven comparative studies, with a total of 10,632 patients, were included. The laparoscopic approach was performed at mean 18-week gestation and the open approach at mean 24-week gestation. LC was associated with decreased risks for fetal (OR 0.42; 95 % CI 0.28–0.63; p < 0.001), maternal (OR 0.42; 95 % CI 0.33–0.53; p < 0.001) and surgical (OR 0.45; 95 % CI 0.25–0.82, p = 0.01) complications. The average length of hospital stay (LOS) was: LC 3.2 days and OC 6.0 days (p = 0.02). The conversion rate from LC to OC was 3.8 %.


The results of this first meta-analysis suggest that LC is associated with fewer maternal and fetal complications than OC during pregnancy. However, 91 % of included patients were in the first or second trimester at the time of surgery. These findings do not account for gestational age during pregnancy, which may be a significant confounding factor. The results support intervention for symptomatic gallstones in the first and second trimester with a laparoscopic approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Ghumman E, Barry M, Grace PA (1997) Management of gallstones in pregnancy. Br J Surg 84:1646–1650

    Article  CAS  PubMed  Google Scholar 

  2. McKeller DP, Anderson CT, Boynton CJ, Peoples JB (1992) Cholecystectomy during pregnancy without fetal loss. Surg Gynecol Obstet 174:465–468

    Google Scholar 

  3. Dhupar R, Simaldone GM, Hamad GG (2010) Is there a benefit to delaying cholecystectomy for symptomatic gallbladder disease during pregnancy? Surg Endosc 24:108–112

    Article  PubMed  Google Scholar 

  4. Society of american gastrointestinal and endoscopic surgeons society (SAGES). Guidelines for diagnosis, treatment and use of laparoscopy for surgical problems during pregnancy. [homepage on the internet] 2016. Available from: Accessed on 9 Jan 2016

  5. Barkun JS, Barkun AN, Sampalis JS, Fried G, Taylor B, Wexler MJ, Goresky CA, Meakins JL (1992) Randomised controlled trial of laparoscopic versus mini cholecystectomy: the McGill Gallstone treatment group. Lancet 340:1116–1119

    Article  CAS  PubMed  Google Scholar 

  6. Soper NJ, Barteau JA, Clayman RV, Ashley SW, Dunnegan DL (1992) Comparison of early postoperative results for laparoscopic versus standard open cholecystectomy. Surg Gynecol Obstet 174:114–118

    CAS  PubMed  Google Scholar 

  7. Pearl J, Price R, Richardson W, Fanelli R (2011) SAGES’ Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 25(11):3479–3492

    Article  PubMed  Google Scholar 

  8. Silvestri MT, Pettker CM, Brousseau CE, Dick MA, Ciarleglio MM, Erekson EA (2011) Morbidity of appendectomy and cholecystectomy in pregnant and non-pregnant women. Obstet Gynecol 118:1261–1270

    Article  PubMed  PubMed Central  Google Scholar 

  9. Date RS, Kaushal M, Ramesh A (2008) A review of the management of gallstone disease and its complications in pregnancy. Am J Surg 196:599–608

    Article  CAS  PubMed  Google Scholar 

  10. Graham G, Baxi L, Tharakan T (1998) Laparoscopic cholecystectomy during pregnancy: a case series and review of the literature. Obstet Gynecol Surv 53:566–574

    Article  CAS  PubMed  Google Scholar 

  11. Reynolds W Jr (2001) The first laparoscopic cholecystectomy. JSLS 5(1):89–94

    PubMed  PubMed Central  Google Scholar 

  12. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  13. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  14. Egger M, Davey S, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. Br Med J 315:629–634

    Article  CAS  Google Scholar 

  15. Conron RW Jr, Abbruzzi K, Cochrane SO, Sarno AJ, Cochrane PJ (1999) Laparoscopic procedures in pregnancy. Am Surg 65(3):259–263

    PubMed  Google Scholar 

  16. Rollins MD, Chan KJ, Price RR (2004) Laparoscopy for appendicitis and cholelithiasis during pregnancy—a new standard of care. Surg Endosc 18:237–241

    Article  CAS  PubMed  Google Scholar 

  17. deBakker JK, Dijiksman LM, Donkervoort SC (2011) Safety and outcome of general surgical open and laparoscopic procedures during pregnancy. Surg Endosc 25:1574–1578

    Article  CAS  Google Scholar 

  18. Cox TC, Huntington CR, Blair LJ, Prasad T, Lincourt AE, Augenstein VA, Heniford BT (1999) Laparoscopic appendectomy and cholecystectomy versus open: a study in pregnant patients. Surg Endosc. doi:10.1007/s00464-015-4244-4

    Google Scholar 

  19. Kuy S, Roman SA, Desai R, Sosa JA (2009) Outcomes following cholecystectomy in pregnant and non-pregnant women. Surgery 146:358–366

    Article  PubMed  Google Scholar 

  20. Barone JE, Bears S, Chen S, Tsai J (1999) Outcome study of cholecystectomy during pregnancy. Am J Surg 177:232–236

    Article  CAS  PubMed  Google Scholar 

  21. Corneille MG, Gallup TM, Bening T, Wolf SE, Brougher C, Myers JG, Dent DL, Medrano G, Xenakis E, Stewart RM (2010) The use of laparoscopic surgery in pregnancy: evaluation of safety and efficacy. Am J Surg 200:363–367

    Article  PubMed  Google Scholar 

  22. Patel SG, Veverka TJ (2002) Laparoscopic cholecystectomy in pregnancy. Current Surg 59(1):74–78

    Article  Google Scholar 

  23. Visser BC, Glasgow RE, Mulvihill KK, Mulvihill SJ (2001) Safety and timing of nonobstetric abdominal surgery in pregnancy. Dig Surg 18(5):409–417

    Article  CAS  PubMed  Google Scholar 

  24. Cosenza CA, Saffari B, Jabbour N, Stain SC, Garry D, Parekh D, Selby RR (1999) Surgical management of biliary gallstone disease during pregnancy. Am J Surg 178:545–548

    Article  CAS  PubMed  Google Scholar 

  25. Glasgow RE, Visser BC, Harris HW, Patti MG, Kilpatrick SJ, Mulvihill SJ (1998) Changing management of gallstone disease during pregnancy. Surg Endosc 12:241–246

    Article  CAS  PubMed  Google Scholar 

  26. Curet MJ, Allen D, Josloff RK, Pitcher DE, Curet LB, Miscall BG, Zucker KA (1996) Laparoscopy during pregnancy. Arch Surg 131:546–551

    Article  CAS  PubMed  Google Scholar 

  27. Davis A, Katz VL, Cox R (1995) Gallbladder disease in pregnancy. J Reprod Med 40(11):759–762

    CAS  PubMed  Google Scholar 

  28. Affleck DG, Handrahan DL, Egger MJ, Price RR (1999) The laparoscopic management of appendicitis and cholelithiasis during pregnancy. Am J Surg 178:523–529

    Article  CAS  PubMed  Google Scholar 

  29. Rizzo AG (2003) Laparoscopic surgery in pregnancy: long-term follow-up. J Laparoendosc Adv Surg Tech A 13:11–15

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Guy D. Eslick.

Ethics declarations


Drs Negin Sedaghat and Amy Cao, Associate Professor Guy Eslick and Professor Michael Cox have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sedaghat, N., Cao, A.M., Eslick, G.D. et al. Laparoscopic versus open cholecystectomy in pregnancy: a systematic review and meta-analysis. Surg Endosc 31, 673–679 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: