Changing management of gallstone-related disease in pregnancy - a retrospective cohort analysis

Scand J Gastroenterol. 2017 Sep;52(9):1016-1021. doi: 10.1080/00365521.2017.1333627. Epub 2017 Jun 9.

Abstract

Objectives: Gallstone-related disease is the second most common non-obstetric cause, following appendicitis, for acute abdomen in pregnancy. This study aimed to investigate treatment strategies, changes over time and outcome.

Materials and methods: All consecutive patients with symptomatic gallstone-related disease during pregnancy admitted to Skane University hospital in Lund and Malmö 2001-2015 were analysed retrospectively. Information regarding the patient, pregnancy and fetus/child was recorded. The material was analysed by dividing it into two equal time periods and by comparing conservative management and surgical intervention.

Results: We included 96 patients with 97 pregnancies. The age was 30 (26-34) years and BMI 28 (24-31). Median length of pregnancy at first admission was 23 (13-31) weeks. The three most common diagnoses were biliary colic (n = 63), cholecystitis (n = 22) and acute pancreatitis (n = 16). Conservative treatment was practiced in 62 (64%) patients and intervention in 35 (36%). Conservatively treated patients were admitted later during pregnancy (week 26 (20-33) versus 17 (10-22), p < .001). Surgically treated patients had a longer total length of stay (all admissions) than conservatively treated patients (p = .001), less readmissions (p = .001) and equal birth outcome. Surgical intervention was more common in the later time period (48% versus 22%, p = .011). Of the conservatively treated patients, 56% were subjected to surgical intervention within 2 years after delivery.

Conclusions: We found that intervention was more common in the later time period, with good results concerning safety, and less readmissions. A majority of the conservatively treated patients had surgical intervention within two years after delivery. Our results support surgical intervention in pregnancy.

Keywords: ERCP; Pregnancy; biliary colic; cholecystectomy; cholecystitis; gallstones; laparoscopic cholecystectomy; pancreatitis.

Publication types

  • Comparative Study

MeSH terms

  • Abortion, Spontaneous / etiology
  • Acute Disease
  • Adult
  • Biliary Dyskinesia / epidemiology
  • Cholangiopancreatography, Endoscopic Retrograde
  • Cholecystectomy, Laparoscopic
  • Cholecystitis / epidemiology*
  • Colic / epidemiology*
  • Female
  • Gallstones / complications*
  • Gallstones / therapy*
  • Humans
  • Pancreatitis / epidemiology*
  • Pregnancy
  • Pregnancy Complications / epidemiology*
  • Pregnancy Complications / therapy
  • Retrospective Studies
  • Sweden