What is the role of laparoscopic cholecystectomy in the treatment of biliary disease during pregnancy?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Biliary colic or uncomplicated cholecystitis in a pregnant patient is treated with conservative management followed by elective laparoscopic cholecystectomy. The use of antibiotics, analgesics, and antiemetics helps most pregnant women avoid surgical intervention. Surgery is generally indicated for patients with recurrent acute cholecystitis that does not respond to maximal medical therapy.

Classically, the second trimester is considered the safest time for surgical treatment. This is because of the increased risk of spontaneous abortion and teratogenesis during the first trimester and the increased risk of premature labor and difficulties with visualization in the third trimester.

At one time, pregnancy was considered to be an absolute contraindication to the laparoscopic approach, out of concern for the potential trocar injury to the uterus and the unknown effects of pneumoperitoneum to the fetal circulation. However, this concern has not been borne out in the literature, and laparoscopic cholecystectomy is now considered safe in pregnant patients.

Reported predictors of fetal complications are laparoscopy, diagnosis, admission urgency, year, hospital size, location, teaching status, and high-risk obstetric cases; predictors of maternal complications are an open procedure and greater patient comorbidity. [32]


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