Trimester-specific safety of laparoscopic versus open abdominal surgery during pregnancy: systematic review and meta-analysis.

BACKGROUND

Current guidelines endorse laparoscopy for non-obstetric abdominal surgery during pregnancy regardless of trimester but recent data suggest trimester-specific fetal risks. The aim of this study was to compare the maternal and fetal safety of laparoscopic versus open surgery, focusing on trimester-specific and pathology-stratified outcomes.

METHODS

This systematic review and meta-analysis was conducted according to the PRISMA 2020 guidelines and was registered in PROSPERO, the international prospective register of systematic reviews (2026 CRD420261295995). PubMed, Embase, and Cochrane Library databases were searched for comparative studies (RCTs and cohort studies) of laparoscopic versus open surgery for acute appendicitis, gallstone disease, and adnexal masses. Random-effects meta-analysis synthesized data on fetal loss, preterm delivery, maternal complications, and length of hospital stay.

RESULTS

In total, 22 studies comprising 28 160 pregnant women (15 786 of whom underwent laparoscopic surgery and 12 374 of whom underwent open surgery) were included. Laparoscopy was associated with a higher risk of fetal loss than open surgery (OR 2.02 (95% c.i. 1.40 to 2.92); P < 0.001). A first-trimester subgroup analysis showed a persistent trend toward higher fetal loss with laparoscopy (OR 1.35 (95% c.i. 0.84 to 2.19)). Laparoscopy reduced preterm delivery (OR 0.56 (95% c.i. 0.34 to 0.94); P = 0.020) and maternal complications (OR 0.45 (95% c.i. 0.30 to 0.68); P < 0.001). Trimester-specific analysis revealed a significantly elevated risk of composite adverse fetal outcomes for laparoscopy during the second trimester (OR 2.35 (95% c.i. 1.15 to 4.77); P = 0.020) and a similar trend in the third trimester.

CONCLUSION

Laparoscopy confers maternal benefits and reduces preterm delivery but is associated with higher fetal loss and elevated composite adverse outcomes in the second trimester.