LAPAROSCOPY DURING PREGNANCY

Objective: To compare the safety and efficacy of laparoscopic surgery with that of open laparotomy in pregnant patients. Design: Six-year ca se-control study. Setting: Tertiary care, university and community hos pitals. Patients: Population-based sample. From 1990 through 1995, 16 pregnant patients underwent laparoscopic surgery (study group) and 18 underwent open laparotomy (control group) during the first or second t rimester. Follow-up ranged from 1 month to 6 years. Intervention: In t he study group, 4 patients underwent appendectomies and 12 underwent c holecystectomies. The control group included 7 appendectomies and 11 c holecystectomies. Main Outcome Measures: The 2 groups were compared fo r age, trimester, surgical time, oxygen saturation, end-tidal carbon d ioxide, return of gastrointestinal tract function, duration of intrave nous or intramuscular narcotics, postoperative stay, gestational age a t delivery, 1- and 5-minute Apgar scores, birth weights, and complicat ions. Results: Age, trimester, oxygenation, end-tidal CO2, gestational age at delivery, Apgar scores, and birth weights were not different b etween the 2 groups. The patients who underwent laparoscopy had signif icantly longer operative times (82 vs 49 minutes), shorter stay (1.5 v s 2.8 days), earlier resumption of regular diet (1.0 vs 2.4 days), and shorter duration of intravenous or intramuscular narcotics (1.2 vs 2. 6 days) (all P < .01). Four complications were found in the laparotomy group vs 6 in the laparoscopy group. Conclusions: Laparoscopic surger y in pregnant women significantly decreases hospitalization, decreases narcotic use, and quickens return to a regular diet when compared wit h open laparotomy in pregnant women. No significant differences betwee n the 2 groups in perioperative morbidity or mortality were present. T hese data suggest that therapeutic laparoscopy during pregnancy in the first or second trimester is safe.