Surgical management of biliary gallstone disease during pregnancy

BACKGROUND: Biliopancreatic gallstone disorders (BPD) manifesting during pr egnancy are relatively rare. The management of these conditions remains con troversial. Although perioperative problems and fetal loss have been report ed, recent publications have advocated an early surgical approach. PATIENTS AND METHODS: Thirty-two pregnant women underwent operation for BPD between January 1993 and December 1997. The mean age was 29 years and rang ed from 18 to 41 years. RESULTS: Twelve patients underwent a laparoscopic cholecystectomy (LC), and 20 open cholecystectomies (OC), including two conversions from laparoscopi c. Seven of the OC patients required additional open CBD exploration and in traoperative choledochoscopy for CBD stones. No maternal mortality was obse rved. A single fetal demise (3%) occurred for a patient with gallstone panc reatitis who underwent open cholecystectomy during her 14th week of gestati on. CONCLUSIONS: Early involvement of the obstetric team, with preoperative and postoperative fetal monitoring, and adequate management of anesthetic and tocolytic agents make cholecystectomy a safe procedure at any stage of preg nancy. Am J Surg. 1999;178:545-548, (C) 1999 by Excerpta Medica, Inc.