Page 35 - Journal of World Association of Laparoscopic Surgeons

Assessment of Feasibility of Laparoscopic Cholecystectomy at the Time of LSCS
develop symptomatic gallstone disease have a high rate of recurrent study, laparoscopic cholecystectomy was completed in a mean
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symptoms. operating time of 24 minutes (15–40 minutes) after LSCS. Additional
After open or laparoscopic cholecystectomy in pregnant port site wounds did not significantly increase the analgesia
women, the rate of preterm labor is 5–7% overall and up to 40% requirements or morbidity and all patients were ambulatory after
17–20
in the third trimester. The rate of spontaneous abortion is 18 hours after surgery. The duration of hospital stay was 3–4 days.
0–18%, and the rate of preterm delivery is 0–22%, depending No additional antibiotics were required.
21
on the severity of the underlying disease and gestational age. Laparoscopic cholecystectomy at the time of cesarean section
In a large retrospective population-based study, fetal outcome in selected patients is a cost-effective method of treatment for
following laparoscopy did not differ from that following gallstone disease, especially in developing countries like India.
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laparotomy. Decision between operative and nonoperative A combined procedure avoids rehospitalization for separate
management regarding the gallstone disease in pregnancy cholecystectomy. With an additional benefit of minimal access
must balance the operative risks against those of the disease surgery, single anesthesia, and single hospital stay, the combined
itself. The main operative risks include fetal teratogenicity and procedure confers valuable advantages for both patient and
spontaneous abortion for patients treated early in pregnancy and hospital in time, cost, and convenience, including avoiding the
preterm labor or delivery in those treated in the third trimester. separation of mother from newborn entailed by reoperation. It
With nonoperative management, the main concern relates to the also prevents the possibility of developing acute cholecystitis
severity of nausea and/or pain and the potential development while the patient is waiting for cholecystectomy. Our results
of complications of gallstones, including acute cholecystitis, indicate that the combination approach of laparoscopic
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obstructive jaundice, and pancreatitis. Five of our patients cholecystectomy at the time of LSCS confers the benefits of
(62.5%) were treated nonoperatively for their symptoms before minimal access for gallstone disease apart from being safe,
delivery. effective, and well accepted.
If a pregnant womanrequires abdominal surgery, the
major issues are the optimal perioperative management and references
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