Laparoscopic cholecystectomy and interventional endoscopy for gallstone complications during pregnancy

Background: Symptomatic or complicated gallstone disease is the most common reason for nongynecological operations during pregnancy. Gallstones are pr esent in 12% of all pregnancies, and more than one-third of patients fail m edical treatment and therefore require surgical endoscopy or laparoscopy. G allstone pancreatitis and jaundice during pregnancy is associated with a hi gh recurrence rate, exposing both fetus and mother to an increased risk of morbidity and mortality. Methods: During a 4-year period, all pregnant patients (n = 37) with sympto matic or complicated gallstone disease were studied prospectively at the La ndeskrankenhaus in Salzburg, Austria. Five patients had an endoscopic retro grade cholangiopancreatogram (ERCP) for biliary pancreatitis or jaundice; t wo of these underwent subsequent laparoscopic cholecystectomy. Another seve n patients required laparoscopic cholecystectomy for severe pain or cholecy stitis; all were in their 13th-32nd gestational week. Access was establishe d by Veress needle in all cases. Insufflation pressure was 8-10 mmHg, and m ean operative time was 62 min. Results All patients delivered full-term, healthy babies. There were no pos tendoscopic or postoperative complications. All patients enjoyed full relie f from their symptoms; there were no recurrences of pancreatitis or jaundic e. Conclusions: The combination of ERCP and laparoscopic cholecystectomy offer s a safe and effective option for the definitive treatment of complicated g allstone disease and intractable pain during pregnancy, and there is suffic ient access for the combined treatment to be employed.