Objective: To study the outcome of laparoscopic cholecystectomy at the time of cesarean section.
Materials and methods: Eight patients were subjected to laparoscopic cholecystectomy at the time of cesarean section. All of them were diagnosed with cholelithiasis at the first antenatal scan. Laparoscopic cholecystectomy was performed by a standard technique, after assessing the anatomy via the cesarean wound.
Results: Laparoscopic cholecystectomy was combined with lower segment cesarean section (LSCS) under general anesthesia in all patients. Surgeries were completed in a mean operating time of 82 minutes. There were no intraoperative or major postoperative complications. No extra antibiotics or analgesics doses were needed. Patients were discharged on the third and the fourth postoperative day.
Conclusion: A combination approach of laparoscopic cholecystectomy at the time of LSCS confers the benefits of minimal access for gallstone disease apart from being safe, effective, and well accepted. With an additional small port site incision, single anesthesia, and single hospital stay, the combined procedure confers valuable advantages in terms of time, hospital stay, cost, and convenience. It also prevents the possibility of developing acute cholecystitis while the patient is waiting for cholecystectomy apart from avoiding the separation of mother from newborn entailed by reoperation.
Kammerer WS. Nonobstetric surgery during pregnancy. Med Clin North Am 1979;63:1157–1163. DOI: 10.1016/S0025-7125(16)31633-9.
Bennett GL, Balthazar EJ. Ultrasound and CT evaluation of emergent gallbladder pathologies. Radiol Clin North Am 2003;41:1203–1216. DOI: 10.1016/S0033-8389(03)00097-6.
Julian B, Bickerstaff KI, et al. Benign diseases of the biliary tract. In: Morris PJ, Malt RA. ed.: Oxford Textbook of Surgery, vol. 1 Oxford: Oxford University Press; 1994. pp. 1209–1239.
Griffin S, Abbassi N, et al. Combined abdominal hysterectomy, cholecystectomy and appendectomy; a study of 25 cases in Abbottabad. J Ayub Med Coll Abbottabad 2006;18:57–59.
Bukovsky I, Schneider D, et al. Sterilization at the time of cesarean section: Tubal ligation or hysterectomy? Contraception 1983;28: 349–356. DOI: 10.1016/0010-7824(83)90037-9.
Gabriele R, Conte M, et al. Cesarean section and hernia repair: simultaneous approach. J Obstet Gynaecol Res 2010;36:944–949. DOI: 10.1111/j.1447-0756.2010.01283.x.
Ochsenbein-Kölble N, Demartines N, et al. Cesarean section and simultaneous hernia repair. Arch Surg 2004;139:893–895. DOI: 10.1001/archsurg.139.8.893.
Pelosi MA, Pelosi 3rd MA, et al. Hand-assisted laparoscopic cholecystectomy at cesarean section. J Am Assoc Gynecol Laparosc 1999;6:491–495. DOI: 10.1016/S1074-3804(99)80017-6.
Pelosi 3rd MA, Pelosi MA, et al. Laparoscopic cholecystectomy at cesarean section. A new surgical option. Surg Laparosc Endosc 1997;7:369–372. DOI: 10.1097/00019509-199710000-00002.
Bernard A, Butler L, et al. Concurrent cesarean section and hand port-assisted laparoscopic cholecystectomy: a safe approach. Surg Laparosc Endosc Percutan Tech 2005;15:283–284. DOI: 10.1097/01.sle.0000183259.78852.a7.
Mushtaque M, Guru IR, et al. Combined lower segment cesarean section and cholecystectomy in single sitting – Our initial experience. J Turkish-German Gynecol Assoc 2012;13:187–190. DOI: 10.5152/jtgga.2012.26.
Ibiebele I, Schnitzler M, et al. Outcomes of Gallstone Disease during Pregnancy: a Population-based Data Linkage Study. Paediatr Perinat Epidemiol 2017;31:522. DOI: 10.1111/ppe.12406.
Sungler P, Heinerman PM, et al. Laparoscopic cholecystectomy and interventional endoscopy for gallstone complications during pregnancy. Surg Endosc 2000;14:267–271. DOI: 10.1007/s004640000037.
Mendez-Sanchez N, Chavez-Tapia NC, et al. Pregnancy and gallbladder disease. Ann Hepatol 2006;5:227–230. DOI: 10.1016/S1665-2681(19)32018-6.
Ko CW, Beresford SA, et al. Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy. Hepatology 2005;41:359–365. DOI: 10.1002/hep.20534.
Valdivieso V, Covarrubias C, et al. Pregnancy and cholelithiasis: pathogenesis and natural course of gallstones diagnosed in early puerperium. Hepatology 1993;17:1–4. DOI: 10.1016/0270-9139(93)90182-M.
Nasioudis D, Tsilimigras D, et al. Laparoscopic cholecystectomy during pregnancy: a systematic review of 590 patients. Int J Surg 2016 Mar;27:165–175. DOI: 10.1016/j.ijsu.2016.01.070.
Cappell MS. The fetal safety and clinical efficacy of gastrointestinal endoscopy during pregnancy. Gastroenterol Clin North Am 2003;32:123–179. DOI: 10.1016/S0889-8553(02)00137-1.
Glasgow RE, Visser BC, et al. Changing management of gall stone disease during pregnancy. Surg Endosc 1998;12:241–246. DOI: 10.1007/s004649900643.
McKellarm DP, Anderson CT, et al. Cholecystectomy during pregnancy without fetal loss. Surg Gynecol Obstet 1992;174:465–468.
Kort B, Katz VL, et al. The effect of nonobstetric operation during pregnancy. Surg Gynecol Obstet 1993;177:371–376.
Reedy MB, Källén B, et al. Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the swedish health registry. Am J Obstet Gynecol 1997 Sep;177(3):673–679. DOI: 10.1016/S0002-9378(97)70163-7.
Erekson EA, Brousseau EC, et al. Maternal postoperative complications after nonobstetric antenatal surgery. J Matern Fetal Neonatal Med 2012;25:2639–2644. DOI: 10.3109/14767058.2012.704445.
Howard F. Laparoscopic surgery during pregnancy. Chir Int 1995;2: 16–22.
Wang H, Zhou A, et al. Application of laparoscopy in the combined surgical procedures of gynecological and digestive disorders in obese women: a retrospective cohort study. Int J Surg 2015 Apr; 16(Pt A):83–87. DOI: 10.1016/j.ijsu.2015.02.006.
Pelossi MA, Villalona E. Laparoscopic hysterectomy, appendicectomy and cholecystectomy. N J Med 1993;90:207–212.