Laparoscopic cholecystectomy with only two 5 mm trocars in a pregnant woman with biliary pancreatitis

Hugo Bonatti


Laparoscopic cholecystectomy (LC) during advanced pregnancy is challenging due to limited intraabdominal space. Patients may be at increased risk for a trocar site hernia. A 35-year-old female in her 22nd week of pregnancy was admitted with acute right upper quadrant pain. Amylase was elevated, LFTs were normal; ultrasound showed acute cholecystitis and no dilated biliary duct. Fetal ultrasound was normal. Antibiotics were started. Amylase peaked at >600 U/L before normalizing, indication for LC was made. MRCP and ERCP were not performed as the patient seemed to have passed a stone. Five mm trocars were placed in the left upper quadrant (LUQ) and umbilicus and a Teleflex minigrasper between the two. The uterus was at the umbilical level. The GB serosa was incised on both sides and a window was created behind the GB midportion and widened towards infundibulum and fundus. GB wall thickening and edema was noted. The critical view was obtained and cystic artery and duct were clipped and divided. The specimen was retrieved through the LUQ port site using a 5 mm endobag after dilatation to 12 mm due to the presence of two large stones. The port site fascia was closed using a suture passer. The postoperative course was uneventful and both mother and baby were well during follow up. In case of biliary pancreatitis during pregnancy, LC should be performed and if ultrasound shows a normal biliary system and amylase/lipase normalize, MRCP/ERCP and IOC may be avoidable. LC with two ports is feasible during pregnancy.