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.
Background: Pregnant women sometimes need emergency surgery on their tummy (abdomen). Surgeons can do this through one big cut (open surgery) or several small cuts—called keyhole (laparoscopic) surgery. Current guidelines say keyhole surgery is safe at any stage of pregnancy.
Aim: To assess if keyhole surgery is as safe as open surgery for both mother and baby, and whether the risks change as the pregnancy progresses.
Methods: The authors combined data from 22 studies that covered over 28 000 pregnant women who had either keyhole or open surgery. Three common reasons for surgery were looked at: appendicitis, gallstones, and ovarian growths. The authors compared how often women lost the baby, gave birth early, had complications, and how long they stayed in hospital.
Findings: Keyhole surgery had benefits for mothers: fewer complications and shorter hospital stays. It also reduced the chance of early birth. However, it was linked to a higher chance of losing the baby compared with open surgery. This risk was highest in the first 3 months of pregnancy. In the second 3 months, keyhole surgery also seemed to carry higher risks for the baby.
Conclusion: Keyhole surgery is better for mothers and helps prevent early births but it may increase the risk of losing the baby. Doctors should not use the same approach for every pregnant woman. Instead, they should choose the method based on the stage of pregnancy and how complex the surgery is. Open surgery is still a good option in some cases.
© The Author(s) 2026. Published by Oxford University Press on behalf of BJS Foundation Ltd.