Trimester-Specific Safety of Laparoscopic versus Open Abdominal Surgery During Pregnancy: A 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. This study compared maternal and fetal safety of laparoscopic versus open surgery, focusing on trimester-specific and pathology-stratified outcomes. METHODS: A systematic review and meta-analysis followed PRISMA 2020 (CRD420261295995). PubMed, Embase and Cochrane Library were searched for comparative studies (randomised controlled trials and cohort studies) of laparoscopic versus open surgery for acute appendicitis, gallstone disease and adnexal masses. Random-effects meta-analysis synthesised data on fetal loss, preterm delivery, maternal complications and hospital stay. RESULTS: Twenty-two studies comprising 28,160 pregnant women (15,786 laparoscopic, 12,374 open) were included. Laparoscopy was associated with a higher risk of fetal loss than open surgery (Odds ratio (OR) 2.02; 95% CI 1.40-2.92; P < 0.001). A first-trimester subgroup analysis showed a persistent trend towards higher fetal loss with laparoscopy (OR 1.35; 95% CI 0.84-2.19). Laparoscopy reduced preterm delivery (OR 0.56; 95% CI 0.34-0.94; P = 0.020) and maternal complications (OR 0.45; 95% CI 0.30-0.68; 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% CI 1.15-4.77; 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.