Journal of Gastrointestinal Surgery

, Volume 17, Issue 11, pp 1953–1959

Delaying Cholecystectomy for Complicated Gallstone Disease in Pregnancy is Associated with Recurrent Postpartum Symptoms

  • Annapoorani Veerappan
  • Andrew J. Gawron
  • Nathaniel J. Soper
  • Rajesh N. Keswani
Original Article

DOI: 10.1007/s11605-013-2330-2

Cite this article as:
Veerappan, A., Gawron, A.J., Soper, N.J. et al. J Gastrointest Surg (2013) 17: 1953. doi:10.1007/s11605-013-2330-2

Abstract

Introduction

Pregnancy is a risk factor for gallstone disease; in some patients, cholecystectomy may be delayed to the postpartum period. Our aim was to examine the effect of antepartum interventions on postpartum outcomes in complicated gallstone disease (CGD) during pregnancy.

Material and Methods

Retrospective analysis of patients seeking medical care for CGD (cholecystitis, choledocholithiasis, or gallstone pancreatitis) during pregnancy at a single tertiary care institution over a 10-year period (2002–2012). Patients were contacted via standardized telephone survey to account for outside hospitalizations.

Results and Discussion

We identified 56 patients with CGD during pregnancy, 42.9 % initially presenting during the second trimester. Choledocholithiasis was the most common diagnosis (n = 30). Antepartum cholecystectomy was performed in 17.9 %. Seventeen patients did not follow up postpartum and did not complete telephone survey. Of the remaining 29 patients, 58.6 % had recurrent postpartum symptoms, 35.3 % recurred within 1 month, and 82.4 % within 3 months of delivery. Antepartum ERCP with biliary sphincterotomy decreased postpartum symptom recurrence (38.5 vs. 75.0 %, p = 0.07).

Conclusions

The majority of patients with CGD who do not undergo antepartum cholecystectomy have recurrent postpartum symptoms often within 3 months postpartum. When appropriate, physicians should advocate for antepartum or early postpartum cholecystectomy to minimize symptom recurrence and unplanned hospitalizations.

Keywords

PregnancyBiliary diseaseERCPPostpartum complications

Abbreviations

CGD

Complicated gallstone disease

LC

Laparoscopic cholecystectomy

ERCP

Endoscopic retrograde cholangiopancreatography

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Annapoorani Veerappan
    • 1
  • Andrew J. Gawron
    • 1
  • Nathaniel J. Soper
    • 2
  • Rajesh N. Keswani
    • 1
  1. 1.Department of Medicine, Division of Gastroenterology & HepatologyFeinberg School of MedicineChicagoUSA
  2. 2.Department of SurgeryFeinberg School of MedicineChicagoUSA