Laparoscopic procedures in pregnancy

As the applications of laparoscopy for general surgical procedures expanded in the 1990s, pregnancy was initially considered a contraindication. Sever al case reports have suggested the safety of laparoscopy in pregnancy. Prev ious clinical studies indicate a higher fetal mortality may exist and advis ed caution. To evaluate the fetal outcome of laparoscopic procedures in pre gnant patients at our institution, we retrospectively reviewed the medical records between 1991 and 1997 and identified 21 pregnant patients who under went either a laparoscopic (n = 12) or open (n = 9) procedure. Appendectomi es, cholecystectomies, and diagnostic laparoscopies were performed. Specifi c variables including age, length of procedure, hospital stay, duration of parenteral analgesic use, gestational age at the time of surgery and delive ry, O-2 saturation and EtCO2 during surgery, APGAR scores, and birth weight s were compared between the two groups. Laparoscopic procedures during preg nancy resulted in shorter hospital stays (34 hours versus 91 hours; P = 0.0 1), less use of parenteral narcotic analgesics (5 hours versus 29 hours; P = 0.05), and no prolongation of operative times (51 minutes versus 63 minut es; P = 0.20). In addition, laparoscopy was performed at earlier gestationa l ages (12 weeks versus 29 weeks; P = 0.001). There was one miscarriage 7 d ays after a laparoscopic cholecystectomy early in the Ist trimester that wa s not statistically significant. Our experience did not show a higher incid ence of fetal loss when comparing laparoscopic to open procedures in pregna nt patients.