1. The use of laparoscopic surgery in pregnancy: evaluation of safety and efficacy Department of Surgery, University of Texas, Health Science Center, San Antonio, USA

2. BACKGROUND: Laparoscopic surgery in pregnant women has become increasingly more common since the 1990s; however, the safety of laparoscopy in this population has been widely debated, particularly in emergent and urgent situations.

3. None obstetric surgery procedures are required in approximately 1 in 635 pregnancies. Acute appendicitis and symptomatic biliary disease being the most common indication. Appendiceal perforation is much higher in the pregnant population. Perforated appendicitis is the most common general surgical cause of fetal loss during pregnancy(20%).

4. Cholecystectomy is required in 45% of pregnant patients with symptomatic cholelithiasis with a 5% rate of fetal loss associated with open cholecystectomy. Pregnancy remains a relative contraindication for laparoscopic procedures.

5. METHODS: A retrospective chart review of all pregnant women following a nonobstetric abdominal operation at a University hospital between 1993 and 2007. Perioperative morbidity and mortality for the mother and fetus were evaluated.

6. Demographics Postoperative length of stay Hospital length of stay Age(y)Subjects(n) 3±24±325 41 Open procedures 3±24±32640appendectomy 27221Cholecystectomy 4±36±52653Laparoscopic procedures 3±35±4249appendectomy 4±36±62639Cholecystectomy 4±1 305salpingectomy/ovarian cystectomy 4±35±42694All procedures

7. Distribution of procedures during the course of pregnancy Estimated GA at surgery(wk) Third trimester Second trimester First trimester 17±910(11%)12(13%)19(20%)Open procedures 17±99(10%)12(13%)19(20%)appendectomy 361(1%)00Cholecystectomy 16±74(4%)28(30%)21(22%)Laparoscopic procedures 11±603(3%)6(6%)appendectomy 18±74(4%)25(27%)9(10%)Cholecystectomy 7±2005(5%)salpingectomy/ovarian cystectomy 16±814(15%)40(43%) All procedures

8. Distribution of procedures in patients with live births and available delivery EGA at time of delivery EGA at time of procedures AgeNo. of subjects 38±319±926±621Open procedures 38±518±726±629Laparoscopic procedures 38±418±826±650All procedures

9. Summary of patients with and without available birth records Delivery records unavailableDelivery at UH 4054No. of patients 25±726±6Average age 1721Open procedures 2329Laparoscopic procedures 13±818±8EGA at time of procedure Specific diagnoses 10 Acute appendicitis uncomplicated 710Acute appendicitis severe 27Acute cholecystitis uncomplicated 02Acute cholecystitis severe 1115 chronic cholecystitis 10 Normal pathology

10. RESULTS: Ninety-four subjects were identified; 53 underwent laparoscopic procedures and 41 underwent open procedures. Cholecystectomy and appendectomy were performed in both groups with salpingectomy/ovarian cystectomy only in the laparoscopic group.

11. No maternal deaths occurred, while fetal loss occurred in 3 cases within 7 days of the operation and in 1 case 7 weeks postoperatively. This and other perinatal complications occurred in 36.7% of the laparoscopic group and 41.7% of the open group.

12. :comments This retrospective review: laparoscopic cholecystectomy and appendectomy were as save as and effective as their open procedures. Affleck et al: 67 laparoscopic operation without any mother and fetus mortality. Halkic et al: 16 laparoscopic operation without any mother and fetus mortality.

13. In this