CHANGING MANAGEMENT OF GALLSTONE DISEASE DURING PREGNANCY

Background: Symptomatic gallstones may be problematic during pregnancy . The advisability of laparoscopic cholecystectomy (LC) is uncertain. The objective of this study is to define the natural history of gallst one disease during pregnancy and evaluate the safety of LC during preg nancy. Methods: Review of medical records of all pregnant patients wit h gallstone disease at the University of California, San Francisco, fr om 1980 to 1996. Results: Of approximately 29,750 deliveries, 47 (0.16 %) patients were treated for gallstone disease, including biliary coli c in 33, acute cholecystitis in 12, and pancreatitis in two. Conservat ive treatment was attempted in all patients but failed in 17 (36%) cas es. Two patients required combined preterm Cesarean-section cholecyste ctomy and 10 required surgery in the early postpartum period for persi stent symptoms. Seventeen patients required cholecystectomy during pre gnancy for biliary colic (10), acute cholecystitis (six), and pancreat itis (one). Three patients were treated with open cholecystectomy. Fou rteen patients underwent LC at a mean gestational age of 18.6 weeks, m ean OR time of 74 min, and mean length of stay of 1.2 days. Hasson can nulation was utilized in 11 patients. Reduced-pressure pneumoperitoneu m (6-10 mmHg) was used in seven patients. Prophylactic tocolytics were used in seven patients, with transient postoperative preterm labor ob served in one. There were no open conversions, preterm deliveries, fet al loss, teratogenicity, or maternal morbidity. Conclusions: In past y ears, symptomatic gallstones during pregnancy were managed conservativ ely or with open cholecystectomy. LC is a feasible and safe method for treating severely symptomatic patients.