Original article Laparoscopic cholecystectomy during pregnancy: A case series Mamta Dagar*, Mala Srivastava, Indrani Ganguli, Ashish Dey Sir Ganga Ram Hospital, New Delhi, India A R T I C L E I N F O Article history: Received 11 August 2017 Received in revised form 20 September 2017 Accepted 6 October 2017 Available online 9 October 2017 Keywords: Laparoscopy Cholecystectomy Pregnancy A B S T R A C T Objective: To study safety, feasibility and short term outcomes of laparoscopic cholecystectomy during pregnancy. Methods: Between January 2013 to December 2016, all patients undergoing laparoscopic cholecystecto- my during pregnancy at our hospital were retrospectively identified. Eight patients underwent laparoscopic cholecystectomy for symptomatic biliary disease during first and second trimester of pregnancy. Laparoscopic cholecystectomy was performed under general anesthesia. Results: During the study period of 4 years from January 2013 to December 2016, 8 patients with gestational ages ranging from 11 to 28 weeks underwent laparoscopic cholecystectomy during pregnancy. Of them 2 patients were in the first trimester and 6 patients in the second trimester. The indication for surgical intervention was unrelenting biliary colic unresponsive to medical management and cholecystitis in 7 patients and gangrenous gall bladder in one patient. The latter patient had undergone successful Endoscopic Retrograde Cholangio Pancreatography (ERCP) followed by laparo- scopic cholecystectomy after 5 days. There were no conversions to open. All patients had an uneventful post-operative recovery. There were no miscarriage or premature births in this group. There was one fetal demise 5 weeks following surgery due to severe oligoamnios, incidence of which is unrelated to laparoscopy. Conclusion: Laparoscopic cholecystectomy during pregnancy is safe for both the mother and the unborn fetus. Surgery is indicated in unrelenting biliary colic or complications of cholelithiasis. Extreme caution during access to the abdominal cavity and keeping pneumoperitoneum pressures and operating times to a minimum should be kept in mind at all times. © 2017 Sir Ganga Ram Hospital. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved. 1. Introduction Biliary tract disease is a common acute surgical condition encountered during pregnancy second only to acute appendici- tis. 1,2 Among various reasons suggested, changes in hormone levels, especially higher levels of progesterone seem to be the main etiological factor. 3 Asymptomatic gallstones are common in pregnancy and have been known to resolve following delivery. Therefore many authors suggest a conservative approach in this group of patients. 4 It is difficult to arrive at a general consensus regarding the optimum line of management but it is generally agreed that cholecystectomy should be performed only if conservative management fails. Failure of nonsurgical manage- ment would generally mean unrelenting pain unresponsive to medications or progression to acute cholecystitis, mucocoele, empyema or gangrene of the gall bladder. Traditionally, laparoscopic interventions for gallstones were recommended only in the second trimester because of anticipated poor maternal and fetal outcomes in the first and third trimester. Second trimester was considered safer because of low risk of miscarriage, the fact that organogenesis is complete by this time and also that the uterus is usually small enough not to interfere with the laparoscopic approach. However recent SAGES guidelines suggests that laparoscopy can safely be performed in any trimester of pregnancy. 5 Symptoms of biliary tract disease may be difficult to interpret during pregnancy. A number of factors including pressure effect of the enlarged uterus on the neighbouring organs displacing them and the increased distance of the abdominal wall from the underlying inflamed organ are some reasons why precise diagnosis of the cause of pain may be difficult to establish. Symptoms may also be nonspecific and common to both the conditions including nausea, vomiting and epigastric discomfort. Various reasons suggested for increased incidence of symptomatic gallstones are increased cholesterol secretion, decreased bile acid pool size, * Corresponding author at: Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, 110060, India. E-mail address: drmamtadagar@gmail.com (M. Dagar). https://doi.org/10.1016/j.cmrp.2017.10.003 2352-0817/© 2017 Sir Ganga Ram Hospital. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved. Current Medicine Research and Practice 7 (2017) 220–223 Contents lists available at ScienceDirect Current Medicine Research and Practice journa l homepage: www.e lsevier.com/locate/cmrp