SAGES guidelines for the use of laparoscopy during pregnancy
SAGES · 2024 · USA
Source and licence
- Authors
- Sunjay S. Kumar, Amelia T. Collings, Claire Wunker et al.
- Title
- SAGES guidelines for the use of laparoscopy during pregnancy
- Journal
- Surgical Endoscopy, 2024
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC11133165
Licence statement of the original publication
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Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
KQ1 should appendectomy (laparoscopic or open) versus nonoperative treatment (antibiotics) be used for acute appendicitis during pregnancy (any trimester)?
- The panel suggests that appendectomy rather than nonoperative treatment should be used for acute appendicitis during pregnancyconditional recommendation, very low certainty of evidence
KQ2 should laparoscopic appendectomy versus open appendectomy be used for acute appendicitis during pregnancy (any trimester)?
- The panel suggests that laparoscopic appendectomy rather than open appendectomy should be used for acute appendicitis when the fundus of the uterus is below the umbilicusexpert opinion due to low quality of evidence
- The panel suggests that laparoscopic or open appendectomy should be used for acute appendicitis when the fundus of the uterus is above the umbilicus, at the surgeon’s discretion. The panel additionally suggests the open establishment of pneumoperitoneum when the laparoscopic approach is utilizedexpert opinion due to low quality of evidence
KQ3 should laparoscopic cholecystectomy versus nonoperative treatment be used for the management of biliary disease during pregnancy (any trimester)?
- The panel suggests that laparoscopic cholecystectomy should be used rather than nonoperative treatment for the management of biliary disease during pregnancyconditional recommendation, very low certainty evidence
KQ4 should common bile duct exploration (CBDE) for symptomatic choledocholithiasis during pregnancy (any trimester) be used compared to ERCP?
- The panel suggests ERCP rather than common bile duct exploration for the treatment of symptomatic choledocholithiasis during pregnancyany trimester, conditional recommendation, expert opinion due to low quality of evidence
Conclusions
- The panel suggests ERCP for the treatment of symptomatic choledocholithiasis during pregnancy. Both modalities appear to have good safety profiles based on the very limited available evidence. CBDE has the benefit of single-stage management when performed at the same time as cholecystectomy but there may be limited expertise with this technique. After the choledocholithiasis is treated, the patient would still be classified as suffering from symptomatic biliary disease during pregnancy and therefore the recommendations and considerations discussed in section “KQ3 should laparoscopic cholecystectomy versus nonoperative treatment be used for the management of biliary disease during pregnancy (any trimester)?” would apply.
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.
Supplementary Information: The online version contains supplementary material available at 10.1007/s00464-024-10810-1.
Contents of the original publication
The section headings of the original.
- Aim of these guidelines and specific objectives
- Description of the health problems
- How to use these guidelines
- Methods
- Guideline panel organization
- Guideline funding & declaration and management of competing interests
- Selection of questions and outcomes of interest
- Evidence review and synthesis
- Determining the certainty of evidence
- Assumed values and preferences
- Development of recommendations
- Guideline document review
- Recommendation for future research
- Recommendations
- KQ1 should appendectomy (laparoscopic or open) versus nonoperative treatment (antibiotics) be used for acute appendicitis during pregnancy (any trimester)?
- KQ2 should laparoscopic appendectomy versus open appendectomy be used for acute appendicitis during pregnancy (any trimester)?
- KQ3 should laparoscopic cholecystectomy versus nonoperative treatment be used for the management of biliary disease during pregnancy (any trimester)?
- KQ4 should common bile duct exploration (CBDE) for symptomatic choledocholithiasis during pregnancy (any trimester) be used compared to ERCP?
- KQ5 should laparoscopic intestinal resection for inflammatory bowel disease during pregnancy (any trimester) be used compared to observation/deferred intervention?
- Discussion
- What’s new in this guideline
- Implementation
- Research recommendations
- Health equity statement
- Updating these guidelines
- Limitations of these guidelines
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