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Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review

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Abstract

Treatment of surgical disease in the gravid patient requires a unique and careful approach where safety of the mother and fetus are both considered. Approaches to diagnosis and therapy of surgical disease in the gravid patient are increasingly clarified and defined in the literature. Laparoscopy, once described as contraindicated in pregnancy, has been steadily accepted and applied as data supporting its safety and use have accumulated. An extensive review of the literature was performed to define the use of laparoscopy in pregnancy. Diagnoses for independent surgical diseases as well as imaging modalities and techniques during pregnancy are reviewed. Preoperative, intraoperative, and postoperative management of the pregnant patient are described and evaluated with focus on use of laparoscopy. Literature supporting safety and efficacy of laparoscopy in cholecystectomy, appendectomy, solid organ resection, and oophorectomy in the gravid patient is outlined. Based on level of evidence, this review includes recommendations specific to surgical approach, trimester of pregnancy, patient positioning, port placement, insufflation pressure, monitoring, venous thromboembolic prophylaxis, obstetric consultation, and use of tocolytics in the pregnant patient.

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Authors and Affiliations

  1. Department of Surgery, University of Utah Medical Center, Salt Lake City, UT, USA

    Heidi Jackson & Steven Granger

  2. Department of Surgery, Intermountain Medical Center, Intermountain Healthcare, 5169 S. Cottonwood St., Suite 410, Salt Lake City, UT, 84107, USA

    Raymond Price

  3. Department of Surgery, Primary Children’s Medical Center, Intermountain Healthcare, Salt Lake City, USA

    Michael Rollins

  4. Department of Surgery, Baystate Medical Center, Springfield, MA, USA

    David Earle

  5. Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA

    William Richardson

  6. Department of Surgery, Berkshire Medical Center, Pittsfield, MA, USA

    Robert Fanelli

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  1. Heidi Jackson
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  2. Steven Granger
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  3. Raymond Price
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  4. Michael Rollins
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  5. David Earle
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  6. William Richardson
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  7. Robert Fanelli
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Correspondence to Raymond Price.

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Jackson, H., Granger, S., Price, R. et al. Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review. Surg Endosc 22, 1917–1927 (2008). https://doi.org/10.1007/s00464-008-9989-6

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