ArticleSurgical endoscopy2025
The impact of laparoscopic cholecystectomy on pregnancy outcomes in the United States.
Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionIn the early days of laparoscopic surgery, there were concerns of adverse outcomes with laparoscopic cholecystectomy during pregnancy especially later in the gestational period. Currently, laparoscopic cholecystectomy has been demonstrated to be safe during any trimester of pregnancy. The purpose of this study was to compare outcomes of cholecystectomy during pregnancy after the widespread use of laparoscopy throughout the US.
methodsThe 2016-2020 Nationwide Readmissions Database was queried for all patients aged 18-45 years undergoing cholecystectomy during pregnancy. The primary outcome was stillbirth and the secondary outcome was prolonged length of stay (LOS) > 5 days. Univariable comparison with chi-squared was performed for each outcome using covariables of laparoscopic versus open surgery, trimester of surgery, patient age, comorbidities, hospital characteristics, and socioeconomic status. Multivariable logistic regression was performed for each outcome using significant covariables from the univariable analysis.
resultsThere were 5,742 patients undergoing cholecystectomy during pregnancy. Laparoscopic surgery was performed in 5,477 (95.4%) patients. Stillbirth occurred in 92 (1.6%) patients overall and there was no significant difference in patients undergoing laparoscopic versus open surgery. The risk factors for stillbirth included: surgery during the second trimester (OR 5.4 [1.6-18.3]) p = 0.01), 2 or more comorbidities (OR 3.1 [1.9-5.1] p < 0.001), and investor-owned hospitals (OR 1.9 [1.2-3.3] p = 0.01). Prolonged LOS was experienced by 1240 (21.6%) patients. The risk of prolonged LOS was increased with open surgery (OR 3.6 [2.7-4.6] p < 0.001) and 2 or more comorbidities (OR 3.1 [2.6-3.7] p < 0.001), large hospital bed size (OR 1.5 [1.3-1.9], p < 0.001) and metropolitan teaching hospital status (OR 1.3 [1.1-1.5], p = 0.009).
conclusionsThis study provides reassuring evidence regarding the safety of laparoscopic cholecystectomy during pregnancy, affirming its viability as a preferred surgical approach. Stillbirth was rare and prolonged length of stay was associated with open surgery. Clinicians should recognize the risk factors such as the timing of surgery and the presence of comorbidities, which may influence the likelihood of adverse outcomes.
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