Objective
To compare the safety and efficacy of laparoscopic surgery with that of open laparotomy in pregnant patients.
Design
Six-year case-control study.
Setting
Tertiary care, university and community hospitals.
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 trimester. Follow-up ranged from 1 month to 6 years.
Intervention
In the study group, 4 patients underwent appendectomies and 12 underwent cholecystectomies. The control group included 7 appendectomies and 11 cholecystectomies.
Main Outcome Measures
The 2 groups were compared for age, trimester, surgical time, oxygen saturation, end-tidal carbon dioxide, return of gastrointestinal tract function, duration of intravenous or intramuscular narcotics, postoperative stay, gestational age at delivery, 1- and 5-minute Apgar scores, birth weights, and complications.
Results
Age, trimester, oxygenation, end-tidal CO2, gestational age at delivery, Apgar scores, and birth weights were not different between the 2 groups. The patients who underwent laparoscopy had significantly longer operative times (82 vs 49 minutes), shorter stay (1.5 vs 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 surgery in pregnant women significantly decreases hospitalization, decreases narcotic use, and quickens return to a regular diet when compared with open laparotomy in pregnant women. No significant differences between the 2 groups in perioperative morbidity or mortality were present. These data suggest that therapeutic laparoscopy during pregnancy in the first or second trimester is safe.
(Arch Surg. 1996;131:546-551)
