Which of the following statements about laparoscopic cholecystectomy are correct?

A. The procedure is associated with less postoperative pain and earlier return to normal activity.

B. The incidence of bile duct injury is higher than for open cholecystectomy.

DISCUSSION: Studies have clearly documented that postoperative pain following laparoscopic cholecystectomy is less than that experienced after open cholecystectomy and that patients can resume normal activity sooner. This appears to be related to the reduced trauma to the abdominal wall by virtue of the very small incisions used in laparoscopic procedures. The best evidence is that the bile duct injury rate (0.4%) is approximately double that for open cholecystectomy. The incidence of this serious complication will probably decrease with improved techniques, better training, and more advanced instrumentation. Only symptomatic patients should have cholecystectomy. Prophylactic removal of the gallbladder is not cost effective. All elective operations are contraindicated in the first trimester, so as to prevent fetal anomalies and spontaneous abortion. The laparoscopic technique is not contraindicated thereafter except in patients in whom peritoneal access cannot safely be established. This is rarely a problem. Premature labor is a risk in the third trimester. Thus, unless cholecystectomy can be avoided altogether during pregnancy, the second trimester is the most propitious time.