the use of laparoscopic surgery in pregnancy: evaluation of safety and efficacy department of...

The use of laparoscopic surgery in pregnancy: evaluation of safety and efficacy

Department of Surgery, University of Texas, Health Science Center, San Antonio, USA

BACKGROUND: Laparoscopic surgery in pregnant women has become increasingly more common since the 1990s; however, the safety of laparoscopy in this population has been widely debated, particularly in emergent and urgent situations.

None obstetric surgery procedures are required in approximately 1 in 635 pregnancies.

Acute appendicitis and symptomatic biliary disease being the most common indication.

Appendiceal perforation is much higher in the pregnant population.

Perforated appendicitis is the most common general surgical cause of fetal loss during pregnancy(20%) .

Cholecystectomy is required in 45% of pregnant patients with symptomatic cholelithiasis with a 5% rate of fetal loss associated with open cholecystectomy.

Pregnancy remains a relative contraindication for laparoscopic procedures.

METHODS :

A retrospective chart review of all pregnant women following a nonobstetric abdominal operation at a University hospital between 1993 and 2007. Perioperative morbidity and mortality for the mother and fetus were evaluated.

Demographics

Subjects(n)

Age(y)Hospital length of stay

Postoperative length of stay

Open procedures

41254±33±2

appendectomy40264±33±2

Cholecystectomy12272

Laparoscopic procedures

53266±54±3

appendectomy9245±43±3

Cholecystectomy39266±64±3

salpingectomy/ovarian cystectomy

5304±14±1

All procedures 94265±44±3

Distribution of procedures during the course of pregnancy

First trimeste

r

Second trimester

Third trimester

Estimated GA at

surgery(wk)

Open procedures

19(20%)12(13%)10(11%)17±9

appendectomy19(20%)12(13%)9(10%)17±9

Cholecystectomy001(1%)36


21(22%)28(30%)4(4%)16±7

appendectomy6(6%)3(3%)011±6

Cholecystectomy9(10%)25(27%)4(4%)18±7

salpingectomy/ovarian cystectomy

5(5%)007±2

All procedures 40(43%)40(43%)14(15%)16±8

Distribution of procedures in patients with live births and available delivery

No. of subjects

AgeEGA at time of procedures

EGA at time of delivery

Open procedures

2126±619±938±3


2926±618±738±5

All procedures 5026±618±838±4

Summary of patients with and without available birth records

Delivery at UH

Delivery records unavailable

No. of patients5440

Average age 26±625±7

Open procedures 2117


2923

EGA at time of procedure

18±813±8

Specific diagnoses

Acute appendicitis uncomplicated

1010

Acute appendicitis severe

107

Acute cholecystitis uncomplicated

72

Acute cholecystitis severe

20

chronic cholecystitis1511

Normal pathology1010

RESULTS :

Ninety-four subjects were identified; 53 underwent laparoscopic procedures and 41 underwent open procedures. Cholecystectomy and appendectomy were performed in both groups with salpingectomy/ovarian cystectomy only in the laparoscopic group .

No maternal deaths occurred, while fetal loss occurred in 3 cases within 7 days of the operation and in 1 case 7 weeks postoperatively. This and other perinatal complications occurred in 36.7% of the laparoscopic group and 41.7% of the open group.

:comments

This retrospective review: laparoscopic cholecystectomy and appendectomy were as save as and effective as their open procedures .

Affleck et al :67 laparoscopic operation without any mother

and fetus mortality. Halkic et al:

16 laparoscopic operation without any mother and fetus mortality.

•In this