Delaying Cholecystectomy for Complicated Gallstone Disease in Pregnancy is Associated with Recurrent Postpartum Symptoms
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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).
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.
- Sungler, P., et al., Laparoscopic cholecystectomy and interventional endoscopy for gallstone complications during pregnancy. Surg Endosc, 2000. 14(3): p. 267–71. CrossRef
- Date, R.S., M. Kaushal, and A. Ramesh, A review of the management of gallstone disease and its complications in pregnancy. Am J Surg, 2008. 196(4): p. 599–608. CrossRef
- Ko, C.W., Risk factors for gallstone-related hospitalization during pregnancy and the postpartum. Am J Gastroenterol, 2006. 101(10): p. 2263–8. CrossRef
- Mendez-Sanchez, N., N.C. Chavez-Tapia, and M. Uribe, Pregnancy and gallbladder disease. Ann Hepatol, 2006. 5(3): p. 227–30.
- Maringhini, A., et al., Biliary sludge and gallstones in pregnancy: incidence, risk factors, and natural history. Ann Intern Med, 1993. 119(2): p. 116–20. CrossRef
- Ko, C.W., et al., Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy. Hepatology, 2005. 41(2): p. 359–65. CrossRef
- Pearl, J., et al., Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc, 2011. 25(11): p. 3479–92. CrossRef
- Soper, N.J., SAGES' guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc, 2011. 25(11): p. 3477–8. CrossRef
- Jelin, E.B., et al., Management of biliary tract disease during pregnancy: a decision analysis. Surg Endosc, 2008. 22(1): p. 54–60. CrossRef
- Dhupar, R., G.M. Smaldone, and G.G. Hamad, Is there a benefit to delaying cholecystectomy for symptomatic gallbladder disease during pregnancy? Surg Endosc, 2010. 24(1): p. 108–12. CrossRef
- Othman, M.O., et al., Conservative management of cholelithiasis and its complications in pregnancy is associated with recurrent symptoms and more emergency department visits. Gastrointest Endosc, 2012. 76(3): p. 564–9. CrossRef
- Barone, J.E., et al., Outcome study of cholecystectomy during pregnancy. Am J Surg, 1999. 177(3): p. 232–6. CrossRef
- Tang, S.J., et al., Safety and utility of ERCP during pregnancy. Gastrointest Endosc, 2009. 69(3 Pt 1): p. 453–61. CrossRef
- Chan, C.H. and R.A. Enns, ERCP in the management of choledocholithiasis in pregnancy. Curr Gastroenterol Rep, 2012. 14(6): p. 504–10. CrossRef
- Chiappetta Porras, L.T., et al., Minimally invasive management of acute biliary tract disease during pregnancy. HPB Surg, 2009. 2009: p. 829020. CrossRef
- Muench, J., et al., Delay in treatment of biliary disease during pregnancy increases morbidity and can be avoided with safe laparoscopic cholecystectomy. Am Surg, 2001. 67(6): p. 539–42; discussion 542–3.
- Delaying Cholecystectomy for Complicated Gallstone Disease in Pregnancy is Associated with Recurrent Postpartum Symptoms
Journal of Gastrointestinal Surgery
Volume 17, Issue 11 , pp 1953-1959
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- Online ISSN
- Springer US
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- Biliary disease
- Postpartum complications
- Industry Sectors
- Author Affiliations
- 1. Department of Medicine, Division of Gastroenterology & Hepatology, Feinberg School of Medicine, NMH/Arkes Family Pavilion Suite 1400, 676 N Saint Clair, Chicago, IL, 60611, USA
- 2. Department of Surgery, Feinberg School of Medicine, Chicago, IL, USA