**7. Patients who are pregnant**

Diseases in the abdomen requiring surgical intervention during pregnancy present unique challenges to their diagnosis and management [17]. These are said to be due to the changes in physiology and abdominal anatomy characteristic of pregnancy. These changes make laparoscopic surgery technically more difficult, the obstetrician must determine the status of pregnancy such as gestational age, viability and inform the patient about the risks related to pregnancy and surgery itself [18].

There are several mechanisms that have been proposed by specialists for increased fetal morbidity and mortality associated with laparoscopic surgery during pregnancy including direct uterine trauma, fetal trauma, intraamniotic CO2 insufflation, trauma to maternal abdominal organs and vessels, decreased uterine blood flow and oxygen delivery, teratogenic effects of anesthetic drugs, fetal acidosis due to CO2 pneumoperitoneum, adverse effects of anesthesia on maternal hemodynamic and acid-base balance, increased risk of thromboembolic disease, the effect of underlying abdominal pathology, manipulation during surgery and effects of postoperative medications [18,20] Therefore laparoscopic cholecystectomy has been used cautiously in pregnant women. This is due to the possible mechanical problems related to the pregnant uterus and the other is fear of fetal injury resulting from instrumentation or the pneumoperitoneum.

#### **7.1 Cases**

To assess the effects of laparoscopic cholecystectomy on both the mother and the unborn fetus, Abuabara et al [19] reviewed their surgical experience over a 5-year period where 22 patients ranging from 17 to 31 years underwent laparoscopic cholecystectomy during pregnancy. They noted that the gestational ages ranged from 5 to 31 weeks where there are two patients who are in their first trimester, 16 in the second and four in the third. Their indications for surgery were persistent nausea, vomiting, pain, and inability to eat in 17 patients, acute cholecystitis in three and choledocholithiasis in two. The surgeons established pneumoperitoneum in all patients and their results were all 22 patients survived the surgical procedure without complications and there were no fetal deaths or premature births related to the procedure. The authors concluded that laparoscopic cholecystectomy during pregnancy is safe for both the mother and the unborn fetus and if at all possible, when laparoscopic cholecystectomy is indicated, it should be performed either in the second trimester or early in the third.

Wishner et al [21], members of the Norfolk Surgical Group, gathered their data for the laparoscopic cholecystectomy cases from May 1991 to June 1994 where they performed the

Laparoscopic Cholecystectomy in High Risk Patients 35

was done in four patients from the below 70 group. They also found out that the mean postoperative stay was longer for older patients above 70 years of age. The authors concluded that simple laparoscopic cholecystectomy is safe in the aged even for patients over 70. They stated that this procedure is associated with a short hospital stay and low

With the success of laparoscopic cholecystectomy on different high risk patients, it is therefore recommended as the treatment of choice. The consequences of this technique including the bile duct injury, influence of pneumoperitoneum on cardiorespiratory system and other complications are outweighed by the benefits that the patients acquire after the surgery and these consequences can be prevented by performing the operation cautiously

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**9. Conclusion** 

**10. References** 

operations on 1,300 patients. There were six of these patients who were operated on during pregnancy. They were able to successfully perform the operation on all the six patients and observed that the overall course of the operation is the same with non-pregnant patients. They reported that there were no significant complications to either the patient or the fetus. It was reported later that all the six patients delivered healthy babies and noted no signs of complications. The authors concluded that laparoscopic cholecystectomy can be performed safely in pregnant patients and that it should be considered in any patient who presents with symptomatic cholelithiasis during pregnancy.
