Nonoperative management of symptomatic cholelithiasis has generally been recommended for pregnant patients. However, a review of our experience with 44 patients at the Los Angeles County-University of Southern California Medical Center indicates that conservative management is associated with recurrent episodes of biliary tract symptoms, often requiring multiple hospitalizations, as well as a significant rate of fetal loss; whereas operation performed during the second trimester was associated with little maternal morbidity, no fetal loss, and a substantial reduction in total hospital days.