Cholecystectomy Should Be Delayed Until After Pregnancy: Group

By Will Boggs MD

February 26, 2019

NEW YORK (Reuters Health) - Cholecystectomy for pregnant women with benign biliary disease should be delayed until after delivery, according to findings from the California Cholecystectomy Group.

"Cholecystectomy during the third trimester results in more premature labor which, in turn, is associated with increased problems for the baby," Dr. Henry A. Pitt from Lewis Katz School of Medicine at Temple University, in Philadelphia, told Reuters Health by email. "Allowing a few more weeks for the baby to mature and be healthy for a lifetime is much more important than having the mother's gallbladder removed urgently during the last stages of pregnancy."

Benign biliary disease is the second most common indication for nonobstetric operations in pregnant women, and current surgical guidelines suggest that cholecystectomy during the third trimester of pregnancy is safe for both the woman and the fetus.

The recommendation to operate during the third trimester over deferment to the postpartum period is based on case reports and small series, Dr. Pitt and colleagues note in the Journal of the American College of Surgeons, online February 12.

The researchers used information from California's Office of Statewide Health Planning and Development database to compare the results of cholecystectomy during the third trimester of pregnancy (403 women) with outcomes in women operated on in the early postpartum period (within 90 days after childbirth; 17,490 women).

After adjustment for various factors, third-trimester cholecystectomy was associated with significantly longer hospital length of stay (by 0.83 days) and 2.05-fold higher odds of 30-day readmission (P=0.002), compared with postpartum cholecystectomy.

Women operated in the third trimester had 88% higher odds (P<0.001) of experiencing adverse maternal outcomes (eclampsia, hemorrhage, and preterm delivery), compared with women operated in the early months after delivery. This increase was driven mainly by the 2.12-fold higher odds of preterm delivery.

"When gallbladder removal was delayed until after delivery, the likelihood of having the operation done laparoscopically was increased, and the need for hospitalization was reduced," Dr. Pitt said.

"Whenever possible," the researchers conclude, "women presenting with benign biliary disease in the third trimester of pregnancy should have their cholecystectomy delayed until the postpartum period."

"We believe that, perhaps, 1% of women who develop symptoms during the third trimester will still need to undergo a cholecystectomy during the third trimester," Dr. Pitt said. "These patients will include those with severe infection of the gallbladder which does not respond to antibiotics and fasting."

SOURCE: https://bit.ly/2EoiLJ2

J Am Coll Surg 2019.

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