Document Detail

Management of biliary tract disease during pregnancy: a decision analysis.
MedLine Citation:
PMID:  17713817     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The appropriate management of biliary tract disease during pregnancy is uncertain. Although laparoscopic cholecystectomy can be performed safely during pregnancy, the timing and indications for this surgical intervention have not been firmly established. METHODS: We constructed a Markov decision analytic model that incorporates maternal well-being and fetal outcome into a choice between nonoperative management (NM) and laparoscopic cholecystectomy (LC) for pregnant women with biliary tract disease (BTD). Our model cycles through weeks of pregnancy for a cohort of 200 gravid women presenting with biliary tract disease in both the first and second trimesters. Weekly state probabilities and utilities for fetal outcome were derived from the literature, while weekly utilities for disease and operative states were estimated in consultation with obstetricians. We cycled the model from 6 to 42 weeks and from 19 to 42 weeks to simulate first and second trimester presentations. Outcomes are expressed in quality pregnancy weeks (QPWs). One QPW is the utility of a normal healthy week of pregnancy. RESULTS: A comprehensive search of the literature yielded a fetal death rate following LC for biliary tract disease of 2.2% and following NM of 7%. Relapse rates were found to be trimester dependent and estimated to be 55%, 55%, and 40% in the first, second, and third trimester, respectively. For a hypothetical cohort of 100 women presenting with biliary tract disease in their first trimester, LC generated 12,800 QPWs compared with 12,400 QPWs for NM, an average gain of 4 QPWs per woman. For the cohort of women entering the model in the second trimester, 11,600 QPWs were accrued by the LC group and 11,400 QPWs by the NM group, an average gain of 2 QPWs per woman. These findings were sensitive only to changes in fetal death rates under the two treatment arms. CONCLUSIONS: Laparoscopic cholecystectomy is superior to nonoperative management for pregnant women presenting in the first or second trimester with biliary tract disease.
Eric B Jelin; Douglas S Smink; Ashley H Vernon; David C Brooks
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Publication Detail:
Type:  Journal Article     Date:  2007-08-23
Journal Detail:
Title:  Surgical endoscopy     Volume:  22     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2007-12-31     Completed Date:  2008-01-28     Revised Date:  2010-03-11    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  54-60     Citation Subset:  IM    
Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
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MeSH Terms
Biliary Tract Diseases / diagnosis,  surgery*
Case-Control Studies
Cholecystectomy, Laparoscopic / adverse effects,  methods*
Cohort Studies
Decision Support Techniques
Fetal Development / physiology
Fetal Mortality / trends*
Follow-Up Studies
Markov Chains
Multivariate Analysis
Pregnancy Complications / diagnosis,  surgery*
Pregnancy Outcome*
Pregnancy Trimester, Second
Pregnancy Trimester, Third
Prenatal Diagnosis / methods
Reference Values
Risk Assessment
Comment In:
J Am Coll Surg. 2010 Mar;210(3):367-9   [PMID:  20193902 ]

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