Analysis of the increasing role of laparoscopy in the management of acute abdomen in pregnancy

This is a review of the epidemiological, diagnostic and therapeutic aspects of acute abdominal conditions during pregnancy. We emphasize the recent changes in surgical criteria that have appeared since the advent of laparoscopic surgery. The incidence of acute appendicitis during pregnancy is 1 in every 1,500 while approximately 4.5% of pregnant women have asymptomatic cholelithiasis and 0.05% acute cholecystitis. Up to 40% of these patients will require surgery during gestation and it is well known that abdominal interventions in this period carry out a higher risk of miscarriage or premature labor. We analyze the most common causes of acute abdomen during pregnancy as well as the special considerations of conservative treatment, open surgery and laparoscopic surgery. We also review the technical aspects of laparoscopic procedures and the safety guidelines by the Society of American Gastrointestinal Endoscopic Surgeons. It is concluded that the laparoscopic approach is safe and effective in the diagnosis and treatment of acute abdominal pathology during pregnancy. The advantages over conventional open surgery have made many surgeons and gynecologists change their criteria in favor of laparoscopy and this is now often their first choice of treatment.