Abstract
Background
The indications for nonemergent operations during pregnancy remain undefined. Many surgeons defer nonemergent operations until after delivery to minimize fetal risk. We wished to determine the outcome of delaying cholecystectomy in pregnant patients hospitalized for nonacute gallbladder disease.
Methods
After approval from the Institutional Review Board, a retrospective case review at a large-volume regional referral center for high-risk obstetrics was performed. All pregnant inpatients from November 2003 to November 2006 who were diagnosed by a general surgeon with symptomatic cholelithiasis, choledocholithiasis, gallstone pancreatitis, biliary dyskinesia or chronic cholecystitis were included.
Results
Fifty-eight patients met the criteria over the 3-year period. Nineteen patients who underwent cholecystectomy during pregnancy were compared with 39 who were observed for gallbladder disease. Patients who were observed during pregnancy and remained at our institution through delivery had a higher rate of pregnancy-related complications (36%). In three cases, complications during pregnancy were directly attributable to gallbladder disease (parenteral nutrition during pregnancy, two unplanned inductions). Two patients (3.4%) were hospitalized for gallbladder disease diagnosed during a previous pregnancy and did not undergo cholecystectomy. Although 71% of the patients who were observed continued to be followed up at this institution for their obstetric care, 56% of those were lost to follow-up for their gallbladder disease. Nine of 39 observed patients (23%) had multiple hospital admissions (range 2–5). Of the 19 patients undergoing cholecystectomy during pregnancy, 3 were performed in the first (16%), 9 in the second (47%), and 7 in the third trimester (37%). Operative complications resulting from laparoscopic cholecystectomy during pregnancy occurred in one patient (cystic duct stump leak, nonoperative management). All cholecystectomies were performed laparoscopically.
Discussion
Delaying cholecystectomy for the hospitalized pregnant patient with gallbladder disease results in increased short- and long-term morbidity. There was high loss to follow-up among patients who were observed during pregnancy. In contrast, cholecystectomy during pregnancy resulted in a low rate of complications, and all were completed laparoscopically. This suggests that operative intervention for nonemergent symptomatic gallbladder disease during pregnancy may be beneficial and reduce overall morbidity.
Similar content being viewed by others
References
Kammerer WS (1979) Non-obstetric surgery during pregnancy. Med Clin North Am 63:1157–1164
Kammerer WS (1987) Non-obstetric surgery in pregnancy. Med Clin North Am 71:551–560
Dietrich CS, Hill CC, Hueman M (2008) Surgical diseases presenting in pregnancy. Surg Clin North Am 88:403–419
Gilat T, Konikoff F (2000) Pregnancy and the biliary tract. Can J Gastroenterol 14:55D–59D
Swisher SG, Schmit PJ, Hunt KK, Hiyama DT, Bennion RS, Swisher EM et al (1994) Biliary disease during pregnancy. Am J Surg 168:576–579
Glasgow RE, Visser BC, Harris HW, Patti MG, Kilpatrick SJ, Mulvihill SJ (1997) Changing management of gallstone disease during pregnancy. Surg Endosc 12:241–246
Cosenza CA, Saffari B, Jabbour N, Stain SC, Garry D, Parekh D et al (1999) Surgical management of biliary gallstone disease during pregnancy. Am J Surg 178:545–548
Date RS, Kaushal M, Ramesh A (2008) A review of the management of gallstone disease and its complications in pregnancy. Am J Surg 196:599–608
Parangi S, Levine D, Henry A, Isakovich N, Pories S (2007) Surgical gastrointestinal disorders during pregnancy. Am J Surg 193:223–232
Scott LD (1992) Gallstone disease and pancreatitis in pregnancy. Gastroenterol Clin North Am 21:803–815
McKellar DP et al (1992) Cholecystectomy during pregnancy without fetal loss. Surg Gynecol Obstet 174(6):465–468
Reedy MB, Kallen B, Kuehl TJ (1997) Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the Swedish Health Registry. Am J Obstet Gynecol 177(3):673–679
Oelsner G et al (2003) Pregnancy outcome after laparoscopy or laparotomy in pregnancy. J Am Assoc Gynecol Laparosc 10(2):200–204
Jackson H et al (2008) Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review. Surg Endosc 22:1917–1927
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dhupar, R., Smaldone, G.M. & Hamad, G.G. Is there a benefit to delaying cholecystectomy for symptomatic gallbladder disease during pregnancy?. Surg Endosc 24, 108–112 (2010). https://doi.org/10.1007/s00464-009-0544-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0544-x