Laparoscopic bile duct exploration during pregnancy: a multi-centre case series and literature review

Background: The physiological changes of pregnancy increase the risk of gallstone formation and choledocholithiasis. Traditionally, endoscopic retrograde cholangiopancreatography (ERCP) has been the main approach for managing choledocholithiasis during pregnancy, but recent progress in laparoscopic bile duct exploration (LBDE) has demonstrated this technique as a safe and effective alternative option. Methods: A retrospective multicenter study of all patients who underwent LBDE during pregnancy from five centers with proven experience in LBDE between January 2010 and June 2020 was performed. The primary endpoint was to analyze the role of LBDE during pregnancy and to further characterize its position as a safe and effective alternative for the management of choledocholithiasis. A systematic review of the published literature relating to LBDE during pregnancy until February 2022 was also performed. Results: Five from 17 centers, with a total of 3950 LBDEs reported performing LBDE during pregnancy with a cumulative experience of eight patients (0.2%). Median surgical time was 75 minutes (range: 60-140 minutes). The bile duct was cleared successfully in all patients and the median hospital stay was 2 days (range: 1-3 days). The literature review identified a total of seven patients with a successful CBD clearance rate of 86%. There were no major maternal, fetal or pregnancy-related complications in any of the total 15 patients included. Conclusion: The limited available data suggests that LBDE during pregnancy is a safe and effective. More evidence reporting outcomes of LBDE during pregnancy is needed before any strong recommendations can be made.