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Laparoscopic surgical resolution of symptomatic biliary pathology during pregnancy: An early therapeutic approach at
Nicolás Fernandez-Barra1, Camila A Fernández1, Enzo A Muñoz1
1División de Obstetricia y Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Background:
Physiologic changes occurring during pregnancy lead to a higher risk for developing biliary diseases. It is estimated that for every 10,000 pregnant individuals, between 1 and 6 will require a cholecystectomy prior to delivery, most of them being done by a laparoscopic approach. Chile has one of the highest prevalence of gallbladder disease worldwide; however, the characterization of laparoscopic cholecystectomy during pregnancy in Hispanic populations has been poorly investigated.
Objective:
To describe maternal and perinatal outcomes among pregnant individuals undergoing laparoscopic cholecystectomy for symptomatic gallbladder disease at a tertiary care center in Chile, across different gestational ages.
Study Design:
A retrospective cohort study was conducted including all pregnant patients who underwent laparoscopic cholecystectomy between January 2002 and August 2023 in the High-Risk Pregnancy unit at the Sótero del Río hospital in Santiago, Chile. Information related to surgery, early postoperative evolution and perinatal outcomes were analyzed.
Results:
A total of 158 pregnant patients who underwent laparoscopic surgery were included. The median gestational age at the time of surgery was 20 + 6 weeks (range 5-37 weeks). Most surgeries (61 %) were performed during the midtrimester, while 18 % were at the third trimester. The median admission-to-surgery interval was three days (range: 0-13), and the median hospitalization time was five days (range: 1-22). The mean gestational age at delivery was 38 weeks, and the rate of preterm birth < 37 weeks was 13.5 %. There were three cases of surgical complications (1.9 %) and five pregnancy losses (3.6 %). There were no cases that required admission to an intermediate/intensive care unit after surgery.
Conclusion:
In this single-center case series, laparoscopic cholecystectomy for symptomatic gallbladder disease during pregnancy was associated with acceptable maternal and perinatal outcomes across a wide range of gestational ages. Laparoscopic cholecystectomy appears feasible at different trimesters of pregnancy. Further studies are needed to determine if this alternative is better than conservative management.
