Abstract
Background
Surgical procedures during pregnancy carry the risk of adverse fetal outcome. We analyzed outcomes of open and laparoscopic approaches in patients treated for symptomatic cholelithiasis and suspected appendicitis. We reviewed the literature for evidence on the safety of both procedures.
Methods
We retrospectively reviewed the data of all patients who underwent surgery for symptomatic cholelithiasis and suspicion of appendicitis during pregnancy between January 2004 and March 2009. Fetal loss, preterm delivery, maternal outcome, and surgical complications were assessed.
Results
Twenty patients were operated on during pregnancy: 5 of 652 (0.8%) patients with symptomatic cholelithiasis and 15 (4.5%) of 331 for suspected appendicitis. All cholecystectomies were performed by laparoscopic procedure; no premature deliveries or fetal death occurred. In patients with suspicion of appendicitis, three appendices sana were diagnosed laparoscopically, and nine laparoscopic appendectomies and three open appendectomies were performed. The outcome was two preterm deliveries and one fetal death.
Conclusion
Reviewing our results and the available literature, we believe that the outcome of surgery during pregnancy is not dictated by the type of procedure but by the type of disease. The gain for fetal outcome in the future most likely lies in the diagnostic pathway rather than the type of surgery.
Similar content being viewed by others
References
Jackson H, Granger S, Price R, Rollins M, Earle D, Richardson W, Fanelli R (2008) Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review. Surg Endosc 22:1917–1927
Pucci RO, Seed RW (1991) Case report of laparoscopic cholecystectomy in the third trimester of pregnancy. Am J Obstet Gynecol 165:401–402
Walsh CA, Tang T, Walsh SR (2008) Laparoscopic versus open appendicectomy in pregnancy: a systematic review. Int J Surg 6:339–344
Halkic N, Tempia-Caliera AA, Ksontini R, Suter M, Delaloye JF, Vuilleumier H (2006) Laparoscopic management of appendicitis and symptomatic cholelithiasis during pregnancy. Langenbecks Arch Surg 391:467–471
McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM (2007) Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 205:534–540
Kammerer WS (1987) Nonobstetric surgery in pregnancy. Med Clin North Am 71:551–560
Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, Fuchs KH, Jacobi C, Jansen FW, Koivusalo AM, Lacy A, McMahon MJ, Millat B, Schwenk W (2002) The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc 16:1121–1143
Curet MJ, Allen D, Josloff RK, Pitcher DE, Curet LB, Miscall BG, Zucker KA (1996) Laparoscopy during pregnancy. Arch Surg 131:546–550
Rollins MD, Chan KJ, Price RR (2004) Laparoscopy for appendicitis and cholelithiasis during pregnancy: a new standard of care. Surg Endosc 18:237–241
Lim HK, Bae SH, Seo GS (1992) Diagnosis of acute appendicitis in pregnant women: value of sonography. AJR Am J Roentgenol 159:539–542
Singh A, Danrad R, Hahn PF, Blake MA, Mueller PR, Novelline RA (2007) MR imaging of the acute abdomen and pelvis: acute appendicitis and beyond. Radiographics 27:1419–1431
Reedy MB, Kallen B, Kuehl TJ (1997) Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the Swedish Health Registry. Am J Obstet Gynecol 177:673–679
Gurbuz AT, Peetz ME (1997) The acute abdomen in the pregnant patient. Is there a role for laparoscopy? Surg Endosc 11:98–102
Lemaire BM, van Erp WF (1997) Laparoscopic surgery during pregnancy. Surg Endosc 11:15–18
Soriano D, Yefet Y, Seidman DS, Goldenberg M, Mashiach S, Oelsner G (1999) Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy. Fertil Steril 71:955–960
Curet MJ (2000) Special problems in laparoscopic surgery. Previous abdominal surgery, obesity, and pregnancy. Surg Clin North Am 80:1093–1110
Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G (2005) Pregnancy outcome following non-obstetric surgical intervention. Am J Surg 190:467–473
Tracey M, Fletcher HS (2000) Appendicitis in pregnancy. Am Surg 66:555–559
Oelsner G, Stockheim D, Soriano D, Goldenberg M, Seidman DS, Cohen SB, Admon D, Novikov I, Maschiach S, Carp HJ, Anderman S, Ben-Ami M, Ben-Arie A, Hagay Z, Bustan M, Shalev E, Carp H, Gemer O, Golan A, Holzinger M, Beyth Y, Horowitz A, Hamani Y, Keis M, Lavie O, Luxman D, Oelsner G, Stockheim D, Rojansky N, Taichner G, Yafe C, Zohar S, Bilanca B (2003) Pregnancy outcome after laparoscopy or laparotomy in pregnancy. J Am Assoc Gynecol Laparosc 10:200–204
Levine D (2006) Obstetric MRI. J Magn Reson Imaging 24:1–15
Greenhalgh R, Punwani S, Taylor SA (2008) Is MRI routinely indicated in pregnant patients with suspected appendicitis after equivocal ultrasound examination? Abdom Imaging 33:21–25
Disclosures
Drs. J. K. de Bakker, L. M. Dijksman, and S. C. Donkervoort have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
de Bakker, J.K., Dijksman, L.M. & Donkervoort, S.C. Safety and outcome of general surgical open and laparoscopic procedures during pregnancy. Surg Endosc 25, 1574–1578 (2011). https://doi.org/10.1007/s00464-010-1441-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-1441-z