Management of symptomatic cholelithiasis in pregnancy

Symptomatic cholelithiasis occurs in pregnancy in our patient population, some of whom are diabetic. But its management remains controversial. How common is the problem? Is our current policy of management appropriate for our patients?

The management of 162 pregnant patients admitted over a ten-year period with symptomatic cholelithiasis was evaluated in a retrospective study. The patients were divided into two groups: Group A, 58 patients with diabetes mellitus, and Group B, 104 nondiabetic patients.

Symptomatic cholelithiasis occurred in only 0.3% of our pregnant patients. Of 162 patients, 148 (91.4%) had successful conservative (nonsurgical) management. There was no fetal loss, premature birth, maternal morbidity or mortality. Fourteen patients who had failure of conservative treatment had surgical management. When the postpartum cholecystectomy hospitalization days were added to the total days of admission for the nonoperative cases, there was a significant difference in the mean total number of days of hospitalizations between the surgical cases, 12.4 days, and the nonsurgical cases, 20.5 days (P<0.001), but not in the mean number of hospitalizations, 2.3 versus 3.3.

Our current policy of conservative management seems optimal. It has, however, been achieved at the price per patient of 8 extra days of hospitalization. In keeping with recent improvements in surgery and the advent of laparoscopic surgery, a more cost-efficient approach would suggest a more aggressive policy.