Laparoscopic cholecystectomy in pregnancy. A safe option during the second trimester?
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I G Martin1, S P Dexter, M J McMahon
1Leeds Institute for Minimally Invasive Therapy and Division of Surgery, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, Great Britain.
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.