title: Laparoscopic cholecystectomy in the third trimester of pregnancy: report of 3 cases.
abstract: OBJECTIVE
  Symptomatic cholelithiasis and acute appendicitis are the most common surgical conditions requiring nonobstetric abdominal surgery during pregnancy. Cholelithiasis is diagnosed in 0.07% of pregnancy and in about 40% of these patients surgery may be required. Pregnancy was once considered an absolute contraindication for laparoscopic surgery, but pregnant patients undergoing laparoscopic surgery have been reported increasingly in the past decade. However, most case reports and case series are confined to patients in the first and second trimester. We report here 3 patients who underwent laparoscopic cholecystectomy in the third trimester and review the relevant literature.
  
  
  METHODS
  Pregnant women in the third trimester who underwent laparoscopic cholecystectomy were reviewed between the years 2000 and 2004 at our hospital.
  
  
  RESULTS
  Three pregnant patients in the third trimester at a gestational age of 28 weeks, and 2 at 26 weeks underwent laparoscopic cholecystectomy. Initial port was placed in all patients by Hasson open technique, few centimeters cephalad to fundal height. The insufflation pressure was maintained between 12 to 14 mm Hg. The duration of surgery ranged from 64 to 80 minutes (mean: 72 min). Obstetric assessment was carried out preoperatively and fetal well-being was monitored postoperatively. Tocolytic agents were used in 2 patients. There were no intraoperative or postoperative complications. All patients were discharged on the second postoperative day. All the 3 patients delivered healthy babies normally at full term (range: 39 to 40 wk).
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy can be carried out safely in the third trimester of pregnancy with minimal risk to the fetus and the mother.
authors.affiliation: Sultan Qaboos University Hospital, Sultanate of Oman, Muscat, Oman. norman@omantel.net.om
authors.forename: Norman Oneil
authors.initials: NO
authors.lastname: Machado
authors.forename: Lovina S
authors.initials: LS
authors.lastname: Machado
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005323:Fetal Monitoring; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D012307:Risk Factors; D015149:Tocolytic Agents / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D015149:Tocolytic Agents