Laparoscopic versus open cholecystectomy in pregnancy: a systematic review and meta-analysis.
The operative management of symptomatic cholelithiasis during pregnancy is either laparoscopic cholecystectomy (LC) or open cholecystectomy (OC). The aim of this systematic review and meta-analysis is to compare the outcomes of the laparoscopic and open approach for cholecystectomy during pregnancy.



A literature search was conducted using MEDLINE, PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL and Current Contents Connect using appropriate search terms. All comparative studies reporting maternal, fetal, and/or surgical complications were included.



Eleven comparative studies, with a total of 10,632 patients, were included. The laparoscopic approach was performed at mean 18-week gestation and the open approach at mean 24-week gestation. LC was associated with decreased risks for fetal (OR 0.42; 95 % CI 0.28-0.63; p < 0.001), maternal (OR 0.42; 95 % CI 0.33-0.53; p < 0.001) and surgical (OR 0.45; 95 % CI 0.25-0.82, p = 0.01) complications. The average length of hospital stay (LOS) was: LC 3.2 days and OC 6.0 days (p = 0.02). The conversion rate from LC to OC was 3.8 %.



The results of this first meta-analysis suggest that LC is associated with fewer maternal and fetal complications than OC during pregnancy. However, 91 % of included patients were in the first or second trimester at the time of surgery. These findings do not account for gestational age during pregnancy, which may be a significant confounding factor. The results support intervention for symptomatic gallstones in the first and second trimester with a laparoscopic approach.
Department of Surgery, Nepean Hospital, Penrith, NSW, Australia.
Negin
N
Sedaghat
Department of Surgery, Nepean Hospital, Penrith, NSW, Australia.|The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School, Nepean Hospital, The University of Sydney, Level 5, South Block, Penrith, NSW, 2751, Australia.
Amy M
AM
Cao
Department of Surgery, Nepean Hospital, Penrith, NSW, Australia. eslickg@med.usyd.edu.au.|The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School, Nepean Hospital, The University of Sydney, Level 5, South Block, Penrith, NSW, 2751, Australia. eslickg@med.usyd.edu.au.
Guy D
GD
Eslick
Department of Surgery, Nepean Hospital, Penrith, NSW, Australia.|The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School, Nepean Hospital, The University of Sydney, Level 5, South Block, Penrith, NSW, 2751, Australia.
Michael R
MR
Cox
D002763:Cholecystectomy / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*
Cholecystectomy; Laparoscopic; Open; Pregnancy