Medical versus surgical management of biliary tract disease in pregnancy

Lu, Erika J.; Curet, Myriam J.; El‐Sayed, Yasser Y.; Kirkwood, Kimberly S.

doi:10.1016/j.amjsurg.2004.09.002

Cited by 142 publications

(67 citation statements)

References 8 publications

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“…Recently a multicenter study compared medical vs surgical management of symptomatic cholelithiasis. In that study, surgery decreased the number of days in hospital and even reduced the rate of labor induction and preterm deliveries [42]. The nonsurgical management led to suboptimal clinical outcome in up to 38% of the women [42,43].…”

Section: Resultsmentioning

confidence: 82%

“…In that study, surgery decreased the number of days in hospital and even reduced the rate of labor induction and preterm deliveries [42]. The nonsurgical management led to suboptimal clinical outcome in up to 38% of the women [42,43]. That study clearly argues in favor of changing the management of gallstone disease during pregnancy from conservative or open cholecystectomy toward early laparoscopic cholecystectomy.…”

Section: Resultsmentioning

confidence: 89%

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Laparoscopic management of appendicitis and symptomatic cholelithiasis during pregnancy

Halkic

Tempia-Caliera

Ksontini

et al. 2006

Langenbecks Arch Surg

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Background Laparoscopic surgery during pregnancy is a challenging procedure that most surgeons are reluctant to perform. The objective of this study was to evaluate whether laparoscopic appendectomy and cholecystectomy is safe in pregnant women. The management of these situations remains controversial. We report a single center study describing the successful management of 16 patients during pregnancy. Methods More than 3,356 laparoscopic procedures were performed in our institutions between May 1990 and June 2005. Sixteen of these patients were operated on in the second and third trimester between 22 and 32 weeks of estimated gestational age. We performed 11 laparoscopic appendectomies and 5 laparoscopic cholecystectomies. We also reviewed the management and operative technique used in these patients. Results In this study, the laparoscopic appendectomy or cholecystectomy was performed successfully in all patients. Three patients were in their second trimester, weeks 22, 23, and 25, and 13 were in the third trimester, weeks 27 (three patients), 28 (five patients), 31 (three patients), and 32 (two patients). No maternal or fetal morbidity occurred. Open laparoscopy was performed safely in all patients and all patients delivered healthy babies.Conclusion From our experience laparoscopic management of appendicitis and biliary colic during pregnancy is safe, however the second trimester is preferable for laparoscopic cholecystectomy. Pregnancy is not a contraindication to the laparoscopic approach to appendicitis or symptomatic cholelithiasis. We believe that laparoscopic operations, when performed by experienced surgeons, are safe and even preferable for the mother and the fetus.

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Section: Resultsmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 89%

Laparoscopic management of appendicitis and symptomatic cholelithiasis during pregnancy

Halkic

Tempia-Caliera

Ksontini

et al. 2006

Langenbecks Arch Surg

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“…But, because biliary colic will recur in 50% of pregnant patients before delivery, symptomatic patients presenting in the first or second trimester, should undergo cholecystectomy, ideally laparoscopic, in the second trimester, with better pregnancy outcome compared with medical therapy. 32,33 An impacted common bile duct stone and worsening gallstone pancreatitis are indications to proceed to endoscopic retrograde cholangiopancreatography, sphincterotomy, and stone extraction under antibiotic coverage; minimization of fluoroscopy and ionizing radiation to the fetus is essential.…”

Section: Gallstones and Biliary Diseasementioning

confidence: 99%

Liver disease in pregnancy

2008

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Abnormal liver tests occur in 3%-5% of pregnancies, with many potential causes, including coincidental liver disease (most commonly viral hepatitis or gallstones) and underlying chronic liver disease. However, most liver dysfunction in pregnancy is pregnancy-related and caused by 1 of the 5 liver diseases unique to the pregnant state: these fall into 2 main categories depending on their association with or without preeclampsia. The preeclampsiaassociated liver diseases are preeclampsia itself, the hemolysis (H), elevated liver tests (EL), and low platelet count (LP) (HELLP) syndrome, and acute fatty liver of pregnancy. Hyperemesis gravidarum and intrahepatic cholestasis of pregnancy have no relationship to preeclampsia. Although still enigmatic, there have been recent interesting advances in understanding of these unique pregnancy-related liver diseases. Hyperemesis gravidarum is intractable, dehydrating vomiting in the first trimester of pregnancy; 50% of patients with this condition have liver dysfunction. Intrahepatic cholestasis of pregnancy is pruritus and elevated bile acids in the second half of pregnancy, accompanied by high levels of aminotransferases and mild jaundice. Maternal management is symptomatic with ursodeoxycholic acid; for the fetus, however, this is a high-risk pregnancy requiring close fetal monitoring and early delivery. Severe preeclampsia itself is the commonest cause of hepatic tenderness and liver dysfunction in pregnancy, and 2%-12% of cases are further complicated by hemolysis (H), elevated liver tests (EL), and low platelet count (LP)-the HELLP syndrome. Immediate delivery is the only definitive therapy, but many maternal complications can occur, including abruptio placentae, renal failure, subcapsular hematomas, and hepatic rupture. Acute fatty liver of pregnancy is a sudden catastrophic illness occurring almost exclusively in the third trimester; microvesicular fatty infiltration of hepatocytes causes acute liver failure with coagulopathy and encephalopathy. Early diagnosis and immediate delivery are essential for maternal and fetal survival. (HEPATOLOGY 2008;47:1067-1076.) M ost pregnant women are young and healthy, and physiological changes in pregnancy must not be mistaken for liver dysfunction (Table 1). Abnormal liver tests occur in 3%-5% of pregnancies, with many potential causes (Table 2). Although relatively uncommon, any liver disease can occur coincidentally in the pregnant patient and pregnancy may occur in a patient with underlying chronic liver disease. However, most liver dysfunction in pregnancy is pregnancy-related 1 and due to one of the 5 liver diseases unique to the pregnant state-hyperemesis gravidarum (HG), intrahepatic cholestasis of pregnancy (ICP), preeclampsia, the HELLP syndrome, and acute fatty liver of pregnancy (AFLP). These conditions are complications of pregnancy itself, and each has a characteristic timing in relation to the trimesters of pregnancy: HG in the first trimester, ICP in the second half of pregnancy, and the other 3 in the third trimes...

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“…21 Það kom ekki á óvart að meðgöngutengdir fylgikvillar reyndust einnig fátíðir, með tíðni fyrirburafaeðinga upp á 3% sem er mjög sambaerilegt við erlendar niðurstöður. 11,22,23 Engin fósturlát tengdust gallsteinasjúkdómum á Landspítala en lýst hefur verið allt að 7% tíðni erlendis. 10 Í þeim tilfellum sem gögn um myndgreiningu voru til staðar gengust allar konurnar nema ein undir ómun, sem er sú rannsókn sem hentar einna best í tilfellum þungaðra kvenna, en hún er án geislunar, ódýr og með gott naemi fyrir steinum í gallblöðru.…”

Section: Umraeðaunclassified