Laparoscopy today is being used increasingly often during pregnancy, most often to perform appendectomy or cholecystectomy or to treat an adnexal mass. Variable fetal outcomes are reported. This review examined the records of 12 pregnant women who, in 1991 to 1997, underwent laparoscopic surgery. For comparison, nine patients had open procedures. Appendectomy and cholecystectomy were done both laparoscopically and by open surgery, whereas some patients had diagnostic laparoscopy.
Patients in the laparoscopic and open surgery groups were similar in age, oxygen saturation, end-tidal CO2 levels, and gestational age at delivery. Birth weights and Apgar scores also were comparable. The postoperative stay averaged 34 hours for patients having laparoscopic surgery and 91 hours after open surgery. Laparoscopic patients received significantly less parenteral narcotic analgesia. The average operating times, 51.3 minutes for open surgery and 63.5 minutes for laparoscopic surgery, did not differ significantly. One fetus was lost 7 days after laparoscopic cholecystectomy, but there was no meaningful difference in fetal outcomes depending on the operative approach.
No longer is pregnancy an absolute contraindication to laparoscopic surgery. Laparoscopy nevertheless should be undertaken cautiously to diagnose or manage abdominal pathology in a pregnant woman, and only when there is no increased risk of fetal loss. Advantages of laparoscopic over open surgery include a shorter recovery time, a lesser need for narcotic analgesia, and a shorter hospital stay.