Laparoscopic cholecystectomy during pregnancy

There is a strong association between pregnancy and gallstones. When acute cholecystitis or recurring bouts of biliary colic occur during pregnancy, medical therapy is usually initiated but occasionally fails. Laparoscopic cholecystectomy has recently been described for the treatment of symptomatic cholelithiasis, but many authors consider pregnancy to be an absolute contraindication to this operation. We herein describe the management of markedly symptomatic cholelithiasis during the second trimester of pregnancy using laparoscopic techniques in five patients. Tocolytic medications were administered perioperatively in two patients, and open laparoscopy or the use of an alternative site for insertion of the initial port was used in all patients. Laparoscopic cholecystectomy without cholangiograms was successful in all five patients and postoperative hospitalization ranged from 24 to 48 h. Uncomplicated term delivery has occurred in three of the five patients; in the other two patients, normal pregnancies are continuing. Laparoscopic cholecystectomy can be performed safely during pregnancy, as long as the patient is monitored carefully and specific precautions are observed.