SAGES guidelines for the use of laparoscopy during pregnancy

Sunjay S Kumar; Amelia T Collings; Claire Wunker; Dimitrios I Athanasiadis; Colin G DeLong; Julie S Hong; Mohammed T Ansari; Ahmed Abou-Setta; Emily Oliver; Vincenzo Berghella; Vamsi Alli; Imran Hassan; Celeste Hollands; Patricia Sylla; Bethany J Slater; Francesco Palazzo

doi:10.1007/s00464-024-10810-1

SAGES guidelines for the use of laparoscopy during pregnancy

Surg Endosc. 2024 May 3. doi: 10.1007/s00464-024-10810-1. Online ahead of print.

Authors

Sunjay S Kumar¹, Amelia T Collings², Claire Wunker³, Dimitrios I Athanasiadis⁴, Colin G DeLong⁵, Julie S Hong⁶, Mohammed T Ansari⁷, Ahmed Abou-Setta⁸, Emily Oliver⁹, Vincenzo Berghella¹⁰, Vamsi Alli⁵, Imran Hassan¹¹, Celeste Hollands¹², Patricia Sylla¹³, Bethany J Slater¹⁴, Francesco Palazzo^{15

16}

Affiliations

¹ Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
² Hiram C. Polk, Jr Department of Surgery, University of Louisville, Louisville, KY, USA.
³ Department of Surgery, Saint Louis University, Saint Louis, MO, USA.
⁴ Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
⁵ Department of Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA.
⁶ Department of Surgery, NewYork-Presbyterian Queens, New York, NY, USA.
⁷ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁸ Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
⁹ Department of Obstetrics, Gynecology and Reproductive Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
¹⁰ Department of Obstetrics & Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
¹¹ Department of Surgery, Mercy Medical Center Cedar Rapids, Cedar Rapids, IA, USA.
¹² Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
¹³ Division of Colon and Rectal Surgery, Mount Sinai Health System, New York, NY, USA.
¹⁴ Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
¹⁵ Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. francesco.palazzo@jefferson.edu.
¹⁶ Thomas Jefferson University, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA. francesco.palazzo@jefferson.edu.

PMID: 38700549
DOI: 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.

Keywords: Appendicitis; Biliary disease; Cholecystitis; ERCP; Guidelines; Inflammatory bowel disease; Surgery in pregnancy.