Scientific paper
Medical versus surgical management of biliary tract disease in pregnancy

Presented at the 56th Annual Meeting of the Southwestern Surgical Congress, Monterey, California, April 18–21, 2004
https://doi.org/10.1016/j.amjsurg.2004.09.002Get rights and content

Abstract

Background

The management of symptomatic cholelithiasis during pregnancy remains controversial. We compared outcomes after medical versus surgical management of biliary tract disease in pregnant patients.

Methods

We reviewed the clinical course of patients with symptomatic cholelithiasis during pregnancy from 1992 to 2002 at two university hospitals.

Results

Seventy-six women with 78 pregnancies were admitted with biliary tract disease. Of the 63 women who presented with symptomatic cholelithiasis, 10 underwent surgery while pregnant. There were no deaths, preterm deliveries, or intensive care unit admissions. Fifty-three patients were treated medically. Their clinical courses were complicated by symptomatic relapse in 20 patients (38%), by labor induction to control biliary colic (8 patients), and by premature delivery in 2 patients. Each relapse in the medically managed group accounted for an additional five days in hospital.

Conclusion

Surgical management of symptomatic cholelithiasis in pregnancy is safe, decreases days in hospital, and reduces the rate of labor induction and preterm deliveries.

Section snippets

Methods

We reviewed the charts of all patients who were hospitalized with biliary colic (BC), acute cholecystitis (AC), gallstone pancreatitis (GSP), or choledocholithiasis (CDS) during pregnancy at the University of California, San Francisco, and at Stanford Medical Center from January 1, 1992 to January 1, 2002. Patients were identified by International Classification of Diseases, Ninth Revision code, and all patients were admitted to the obstetrical service. Data were extracted from charts of 76

Results

Thirty-one patients with 32 pregnancies at the University of California, San Francisco, and 45 patients with 46 pregnancies at Stanford Hospital and Clinics were identified. There was one twin pregnancy, one quadruplet pregnancy, and two patients who presented during consecutive pregnancies with biliary disease. Presenting diagnoses included 43 cases of BC, 20 cases of AC, 12 cases of GSP, and 3 cases of CDS. The presenting symptoms are summarized in Table 1. Fever and tachycardia were less

Comments

The appropriate management of biliary tract disease during pregnancy is controversial. Some authors advocate avoiding surgery [2], [9], [10], [11], whereas more recent studies favor aggressive surgical management [1], [7], [12]. Many of the surgical series consist of few patients over a long time period, which bridges the introduction of laparoscopic technique. We were able to accumulate a large number of patients by combining data from two major urban teaching hospitals. Presenting symptoms

Conclusion

We have shown that pregnant patients with symptomatic cholelithiasis have a high rate of symptomatic relapse during pregnancy. Relapse rates are similar for patients with BC and AC. A significant number of patients present with more severe disease at the time of relapse, including choledocholithiasis and gallstone pancreatitis. Pregnant patients with biliary tract disease should be counseled regarding the data and advised to consider cholecystectomy for symptomatic disease. Surgical management

References (17)

There are more references available in the full text version of this article.

Cited by (120)

View all citing articles on Scopus
View full text