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SAGES guidelines for the use of laparoscopy during pregnancy

Kumar, Sunjay S.
; 
Collings, Amelia T.
; 
Wunker, Claire
; 
Athanasiadis, Dimitrios I.
; 
DeLong, Colin G.
; 
Hong, Julie S.
; 
Ansari, Mohammed T.
; 
Abou-Setta, Ahmed
; 
Oliver, Emily
; 
Berghella, Vincenzo
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Journal article
Date
2024-05-03
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Committee member
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Department
Obstetrics, Gynecology and Reproductive Sciences
Subject
Appendicitis
 Biliary disease
 Cholecystitis
 ERCP
 Guidelines
 Inflammatory bowel disease
 Surgery in pregnancy
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https://scholarshare.temple.edu/handle/20.500.12613/12064
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https://doi.org/10.1007/s00464-024-10810-1
Abstract
Background When pregnant patients present with nonobstetric pathology, the physicians caring for them may be uncertain about the optimal management strategy. The aim of this guideline is to develop evidence-based recommendations for pregnant patients presenting with common surgical pathologies including appendicitis, biliary disease, and inflammatory bowel disease (IBD). Methods The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines Committee convened a working group to address these issues. The group generated five key questions and completed a systematic review and meta-analysis of the literature. An expert panel then met to form evidence-based recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Expert opinion was utilized when the available evidence was deemed insufficient. Results The expert panel agreed on ten recommendations addressing the management of appendicitis, biliary disease, and IBD during pregnancy. Conclusions Conditional recommendations were made in favor of appendectomy over nonoperative treatment of appendicitis, laparoscopic appendectomy over open appendectomy, and laparoscopic cholecystectomy over nonoperative treatment of biliary disease and acute cholecystitis specifically. Based on expert opinion, the panel also suggested either operative or nonoperative treatment of biliary diseases other than acute cholecystitis in the third trimester, endoscopic retrograde cholangiopancreatography rather than common bile duct exploration for symptomatic choledocholithiasis, applying the same criteria for emergent surgical intervention in pregnant and non-pregnant IBD patients, utilizing an open rather than minimally invasive approach for pregnant patients requiring emergent surgical treatment of IBD, and managing pregnant patients with active IBD flares in a multidisciplinary fashion at centers with IBD expertise.
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Kumar, S.S., Collings, A.T., Wunker, C. et al. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 38, 2947–2963 (2024). https://doi.org/10.1007/s00464-024-10810-1
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Springer Science and Business Media
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Surgical Endoscopy, Vol. 38, Iss. 6
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