Document Detail


Is there a benefit to delaying cholecystectomy for symptomatic gallbladder disease during pregnancy?
MedLine Citation:
PMID:  19517178     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The indications for nonemergent operations during pregnancy remain undefined. Many surgeons defer nonemergent operations until after delivery to minimize fetal risk. We wished to determine the outcome of delaying cholecystectomy in pregnant patients hospitalized for nonacute gallbladder disease. METHODS: After approval from the Institutional Review Board, a retrospective case review at a large-volume regional referral center for high-risk obstetrics was performed. All pregnant inpatients from November 2003 to November 2006 who were diagnosed by a general surgeon with symptomatic cholelithiasis, choledocholithiasis, gallstone pancreatitis, biliary dyskinesia or chronic cholecystitis were included. RESULTS: Fifty-eight patients met the criteria over the 3-year period. Nineteen patients who underwent cholecystectomy during pregnancy were compared with 39 who were observed for gallbladder disease. Patients who were observed during pregnancy and remained at our institution through delivery had a higher rate of pregnancy-related complications (36%). In three cases, complications during pregnancy were directly attributable to gallbladder disease (parenteral nutrition during pregnancy, two unplanned inductions). Two patients (3.4%) were hospitalized for gallbladder disease diagnosed during a previous pregnancy and did not undergo cholecystectomy. Although 71% of the patients who were observed continued to be followed up at this institution for their obstetric care, 56% of those were lost to follow-up for their gallbladder disease. Nine of 39 observed patients (23%) had multiple hospital admissions (range 2-5). Of the 19 patients undergoing cholecystectomy during pregnancy, 3 were performed in the first (16%), 9 in the second (47%), and 7 in the third trimester (37%). Operative complications resulting from laparoscopic cholecystectomy during pregnancy occurred in one patient (cystic duct stump leak, nonoperative management). All cholecystectomies were performed laparoscopically. DISCUSSION: Delaying cholecystectomy for the hospitalized pregnant patient with gallbladder disease results in increased short- and long-term morbidity. There was high loss to follow-up among patients who were observed during pregnancy. In contrast, cholecystectomy during pregnancy resulted in a low rate of complications, and all were completed laparoscopically. This suggests that operative intervention for nonemergent symptomatic gallbladder disease during pregnancy may be beneficial and reduce overall morbidity.
Authors:
Rajeev Dhupar; Gina Mantia Smaldone; Giselle G Hamad
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Publication Detail:
Type:  Journal Article     Date:  2009-06-11
Journal Detail:
Title:  Surgical endoscopy     Volume:  24     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-21     Completed Date:  2010-04-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  108-12     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Pittsburgh Medical Center, Suite 390, Pittsburgh, PA 15213, USA.
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MeSH Terms
Descriptor/Qualifier:
Cholecystectomy, Laparoscopic*
Female
Gallbladder Diseases / complications,  surgery*
Humans
Pregnancy
Pregnancy Complications / etiology,  surgery*
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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