Pregnancy and high parity increase the risk of cholelithiasis and its complications during pregnancy. Laparoscopic cholecystectomy for failed conservative treatment of symptomatic cases during pregnancy is no longer been a contraindication. The potential risk of pneumoperitoneal pressure and CO2 insufflation triggered the use of modified techniques as gasless and low pressure cholecystectomy for materno-fetal safety.
Patients and methods: Thirteen pregnant patients with indicated cholecystectomy were randomly assigned for either low-pressure laparoscopy (LPL) (6 patients) or gasless laparoscopy (GL) (7 patients). Patients were compared for respiratory and blood gases changes, hemodynamic changes, anesthetic requirements, surgical and early postoperative outcomes and materno-fetal well-being   during   hospitalization   and   they   were   followed   up   till   delivery.
Results: After CO2 insufflation there were significant differences between the 2 groups with increase in the cardiopulmonary parameters namely; PaCO2, PetCO2 , peak airway pressure, heart rate and the mean arterial blood pressure and a decrease in pH in the LPL group. The operating time and anesthetic drugs used were significantly more for the GL group. No recorded differences in the postoperative abdominal pain, postoperative nausea and vomiting (PONV) and fetal heart rate changes.
Conclusion: Both low pressure and gasless laparoscopy provide a safe technique for laparoscopic cholecystectomy during pregnancy. However, gasless technique is associated with lower cardiopulmonary effects, despite its longer operating time. In patients with compromised cardiopulmonary function during pregnancy, the gasless technique provides a safer method to avoid the potential adverse effects of pneumoperitoneal pressure and CO2 insufflation.