Laparoscopic cholecystectomy during pregnancy

INTRODUCTION: Acute cholecystitis is the second most common nonobstetric emergency during pregnancy, after acute appendicitis. Once considered to be a contraindication to laparoscopic cholecystectomy in the past, several recent reports have documented the successful use of laparoscopic cholecystectomy during pregnancy. This study shows our experience of laparoscopic cholecystectomy during pregnancy in 20 patients.
MATERIAL AND METHODS: We have done laparoscopic cholecystectomy in 20 pregnant patients over a period of 11 years from January 1993 to 2004. We placed the patient in 30° left lateral position with minimal reverse Trendelenberg to displace the gravid uterus away from the inferior vena cava. In patients who were in the third trimester, the umbilical port had to be shifted up in the midline after palpating the uterus. Intra-abdominal pressure was kept as low as possible in the range of 10-12 mmHg.
RESULTS: Out of the 20 pregnant patients who underwent laparoscopic cholecystectomy, 16 patients were in the second trimester and four were in the third trimester. The most common presentation was pain in the right upper abdominal quadrant with/without vomiting. All the patients went on to deliver at the full term; however, tocolytic agents were used in two patients.
CONCLUSION: All pregnant patients requiring cholecystectomy in the second and third trimesters should be offered the advantages of the laparoscopic cholecystectomy, provided the specific issues about anesthesia, position of the patient, and surgical technique are addressed properly, and meticulous perioperative monitoring is done.