Laparoscopic Surgery in Pregnancy

Abstract

Surgical emergencies requiring abdominal exploration are uncommon during pregnancy. The estimated frequency of nonobstetric surgery during pregnancy is approximately 0.75%–2% [4]. The most common nonobstetric/nongynecologic condition requiring surgical treatment in the pregnant patient is acute appendicitis, followed by acute cholecystitis [21]. With the exception of ectopic pregnancy, laparotomy remains the current gold standard for intra-abdominal surgery in the obstetric population. In the nonobstetric population, however, laparoscopy has become the most popular method. The benefits of laparoscopy include: shorter operating time, and thereby less exposure to anesthetic agents [8], the ability to diagnose and treat during the same procedure [19], less postoperative pain, minimization of postoperative pulmonary complications [15], rapid return of gastrointestinal function, and smaller incisions, all resulting in shorter hospital stays and faster recoveries [14, 16]. These benefits are equally relevant to the obstetric population; however, data regarding the safety of laparoscopy [4] and the effects of prolonged carbon dioxide pneumoperitoneum on the fetus are sparse [20]. Pregnancy, therefore, remains a relative contraindication to laparoscopy [20], despite case reports attesting to its safety and favorable perinatal outcome [18,19, 21]. As surgeons gain expertise in laparoscopic procedures, one can foresee a concomitant increase in the performance of laparoscopy in the pregnant patient [4]. It is prudent, therefore, to familiarize ourselves with the principles of laparoscopically induced pneumoperitoneum and anticipate the pathophysiologic effects it may have on the mother and fetus.