Laparoendoscopic single-site cholecystectomy in a pregnant patient
A 33-year-old woman in the 16th week of her first pregnancy experienced two episodes of upper abdominal pain suggestive of biliary colic. Hematological and biochemical parameters were normal but ultrasonography showed previously undiagnosed multiple small gallbladder calculi. Two weeks later she experienced another episode of abdominal pain during which the liver function tests including bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase were marginally elevated. An endoscopic ultrasound (EUS) showed a patulous ampulla indicative of a recently passed bile duct stone and normal calibre bile ducts. At this point she was referred for a surgical consultation and was counselled regarding a LESS-chole. While awaiting her surgery scheduled 3 days later she developed another episode of abdominal and back pain. The serum amylase and lipase were elevated but the white cell count, liver function tests, serum calcium, and lactate dehydrogenase (LDH) were normal. This episode of mild acute pancreatitis settled within 48 h and a repeat EUS was normal. A LESS-chole was undertaken during the same admission. At the time of surgery she was in the 20th week of her pregnancy. An obstetric consultation was obtained and she was started on inj. terbutaline (Bricanyl, Astra-Zeneca, Mumbai, India) 5 mg subcutaneously on the evening before the surgery. Fetal heart monitoring was initiated on the morning of surgery and continued at an interval of 2 h in the postoperative period until discharge.