Laparoscopic surgical resolution of symptomatic biliary pathology during pregnancy: An early therapeutic approach at any gestational age

Abstract

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.