Laparoscopic surgery in pregnancy: long-term follow-up

To describe the long-term consequences of laparoscopic surgery during pregnancy. Laparoscopic surgery is well established in the surgical community. Laparoscopic surgery in the pregnant patient is not yet broadly accepted; concern has been for fetal wastage, effects of carbon dioxide (CO(2)) on the developing fetus, and long-term sequelae during childhood development. This report documents 11 laparoscopic cases in pregnancy with follow-up of 1 to 8 years. The patients were in their 16th to 28th week of pregnancy. Two patients had chronic cholecystitis and biliary colic resulting in weight loss and multiple admissions. Three patients had acute cholecystitis, and three patients had acute appendicitis. Two patients underwent exploration for a diagnosis of acute abdomen, and both were found to have small bowel obstruction. All patients had general anesthesia and underwent an open Hasson trocar procedure with end-tidal CO(2) monitoring, sequential compression devices, and partial left decubitus positioning. Insufflation pressure was maintained at 10 mm Hg. The operative time ranged from 25 to 90 minutes. Successful laparoscopic surgery was performed in 10 cases, with one conversion to an open procedure. Intraoperative and postoperative fetal monitoring was performed for at least 24 hours. No fetal distress or demise occurred, nor were any tocolytics used. The resultant children were then monitored, and no evidence of developmental or physical abnormalities was detected during the study period. Laparoscopic surgery is now proving to be as safe as open surgery in pregnancy. This article reports long-term follow-up with no deleterious effects to either mothers or children.