Laparoscopic cholecystectomy ok in pregnancy: 150 successful cases.(Obstetrics)

LAS VEGAS -- A total of 150 successful laparoscopic cholecystectomies have been reported in pregnant women who were unresponsive to medical management, suggesting that this procedure is safe during pregnancy, Dr. Raymond J. Lanzafame said.

When performed improperly, laparoscopic cholecystectomy can cause life-threatening injuries. In addition, many aspects of its use during pregnancy are controversial, including whether and when to operate; how and where to place trocars; the type and duration of fetal monitoring; the safety of insufflation gases and best insufflation pressure; the role of cholangiography; and the potential long-term effects on the fetus.

Nearly 4% of pregnant women develop asymptomatic cholelithiasis. Acute chotecystitis is the second most common nonobstetric emergency (after appendicitis) during pregnancy, occurring in 1-6 per 10,000 pregnancies and requiring surgery in 40% of cases.

Multiparity has been associated with an increased risk for developing gallstones, he said at an international congress of the Society of Laparoendoscopic Surgeons.

Traditional medical dogma says to delay the surgery until after delivery, but some surgeons perform laparoscopic cholecystectomy in patients with repeated episodes of pain or biliary complications such as choledocholithiasis or pancreatitis. Most patients can be managed with bed rest, analgesics, intravenous fluids, and nasogastric suction if emesis is severe. Antibiotics are appropriate in complex cases. Many physicians use prophylactic antibiotics to prevent sequelae of acute cholecystitis, but this remains ...