Is there a benefit to delaying cholecystectomy for symptomatic gallbladder disease during pregnancy?

The indications for nonemergent operations during pregnancy remain undefined. Many surgeons defer nonemergent operations until after delivery to minimize fetal risk. We wished to determine the outcome of delaying cholecystectomy in pregnant patients hospitalized for nonacute gallbladder disease.

After approval from the Institutional Review Board, a retrospective case review at a large-volume regional referral center for high-risk obstetrics was performed. All pregnant inpatients from November 2003 to November 2006 who were diagnosed by a general surgeon with symptomatic cholelithiasis, choledocholithiasis, gallstone pancreatitis, biliary dyskinesia or chronic cholecystitis were included.

Fifty-eight patients met the criteria over the 3-year period. Nineteen patients who underwent cholecystectomy during pregnancy were compared with 39 who were observed for gallbladder disease. Patients who were observed during pregnancy and remained at our institution through delivery had a higher rate of pregnancy-related complications (36%). In three cases, complications during pregnancy were directly attributable to gallbladder disease (parenteral nutrition during pregnancy, two unplanned inductions). Two patients (3.4%) were hospitalized for gallbladder disease diagnosed during a previous pregnancy and did not undergo cholecystectomy. Although 71% of the patients who were observed continued to be followed up at this institution for their obstetric care, 56% of those were lost to follow-up for their gallbladder disease. Nine of 39 observed patients (23%) had multiple hospital admissions (range 2-5). Of the 19 patients undergoing cholecystectomy during pregnancy, 3 were performed in the first (16%), 9 in the second (47%), and 7 in the third trimester (37%). Operative complications resulting from laparoscopic cholecystectomy during pregnancy occurred in one patient (cystic duct stump leak, nonoperative management). All cholecystectomies were performed laparoscopically.

Delaying cholecystectomy for the hospitalized pregnant patient with gallbladder disease results in increased short- and long-term morbidity. There was high loss to follow-up among patients who were observed during pregnancy. In contrast, cholecystectomy during pregnancy resulted in a low rate of complications, and all were completed laparoscopically. This suggests that operative intervention for nonemergent symptomatic gallbladder disease during pregnancy may be beneficial and reduce overall morbidity.