Cholecystectomy in pregnant women with complicated biliary pathology at the Hospital de Clínicas
DOI:
https://doi.org/10.31837/cir.urug/8.1.17Keywords:
cholecystectomy, pregnancy, cholelithiasis, cholecystitis, cholangitis, pancreatitisAbstract
The incidence of biliary pathology is high in our country; during pregnancy it is favored by hormonal and mechanical factors. Biliary pathology being the second cause of acute non-obstetric abdominal symptoms. The management of biliary complications is handled differently in our Hospital, especially with regard to indicating surgery during pregnancy.
The objective was to compare the opportunity of cholecystectomy in pregnant women with complicated biliary pathology in our center versus the evidence at an international level.
An observational, retrospective, cross-sectional and descriptive study was carried out in the period from January 1, 2017 to December 31, 2021, at the Hospital de Clínicas Dr. Manuel Quintela, Montevideo Uruguay.
57 patients were included. Average age 26 years.
81% manifested in the second and third trimester.
The diagnoses were: acute cholecystitis (AC) in 28%; acute cholangitis 45.6%, acute pancreatitis (AP) 17.5% and symptomatic gallstones in 5.3%. 47% of the patients included in the study were not cholecystectomized at the time of data analysis.
Only 30% of pregnant women were operated on.
Conclusions: Only a third of pregnant women undergo cholecystectomy at the Hospital de Clínicas. The studies agree that cholecystectomy in pregnant women is safe in all trimesters; the treatment will be adjusted to each case according to the experience of the team and the resources of the environment.
Downloads
References
Ibiebele I, Schnitzler M, Nippita T, Ford JB. Outcomes of Gallstone Disease during Pregnancy: a Population-based Data Linkage Study. Paediatr Perinat Epidemiol. 2017;31(6):522-530. doi: 10.1111/ppe.12406.
Nan X, Chan E, Wong KSC, Ng J, Izwan S, Cooper M. Laparoscopic Cholecystectomy in Pregnancy: A Seven-Year Retrospective Study From an Australian Tertiary Center. Cureus. 2023;15(12):e50034. doi: 10.7759/cureus.50034.
Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, et al. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines. J HepatobiliaryPancreat Sci. 2013;19(5):578–85. doi: 10.1007/s00534-012-0548-0.
Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25(1):55-72. doi: 10.1002/jhbp.516.
Miura F, Okamoto K, Takada T, Strasberg SM, AsbunHJ, Pitt HA, et at. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci. 2018;25(1):31-40. doi: 10.1002/jhbp.509.
Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):17-30. doi: 10.1002/jhbp.512.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11. doi: 10.1136/gutjnl-2012- 302779.
Lorente L, Garat F, Alonzo I, De Agostini M, Cordano C. Screening de parto pretérmino mediante ecografia transvaginal. Guías para la aplicación clínica del ultrasonido obstétrico y ginecológico. Clínica ginecotocologica B; 2017
Sociedad Española de Ginecología y Obstetricia. Guía de Asistencia Práctica* Parto pretérmino. Prog Obstet Ginecol 2020;63:283-321
Murillo MC. Patología de vías biliares y embarazo. Rev Med Cos Cen. 2012;69(601):163-169
Hantouli MN, Droullard DJ, Nash MG, Benson LS, Wright AS, Flum D, et al. Operative vs Nonoperative Management of Acute Cholecystitis During the Different Trimesters of Pregnancy. JAMA Surg. 2024;159(1):28-34. doi: 10.1001/jamasurg.2023.5803.
Cheng V, Matsushima K, Sandhu K, Ashbrook M, Matsuo K, Inaba K, et at. Surgical trends in the management of acute cholecystitis during pregnancy. Surg Endosc. 2021;35(10):5752-5759. doi: 10.1007/s00464-020-08054-w.
Kumar-M P, Singh AK, Samanta J, Birda CL, Kumar N, Dhar J, et al. Acute pancreatitis in pregnancy and its impact on the maternal and foetal outcomes: A systematic review. Pancreatology. 2022;22(2):210-218. doi: 10.1016/j.pan.2021.12.007.
Mali P. Pancreatitis in pregnancy: etiology, diagnosis, treatment, and outcomes. Hepatobiliary Pancreat Dis Int . 2016;15(4):434-8. doi: 10.1016/s1499-3872(16)60075-9.
Rivera-Alonso D, Ruano-Campos A, Hernández-Pérez C, Pérez-Jiménez AE, Álvarez Sánchez C, Torres García AJ, et at. Acute cholecystitis during pregnancy. surgical indication and treatment recommendations. Annals of Mediterranean Surgery 2019;2(2):05-12.
Nasioudis D, Tsilimigras D, Economopoulos KP. Laparoscopic cholecystectomy during pregnancy: A systematic review of 590 patients. Int J Surg. 2016;27:165-175. doi: 10.1016/j.ijsu.2016.01.070.
Pearl JP, Price RR, Tonkin AE, Richardson WS, Stefanidis D. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc. 2017;31(10):3767-3782. doi:10.1007/s00464-017-5637-3.
Weiner E, Mizrachi Y, Keidar R, Kerner R, Golan A, Sagiv R. Laparoscopic surgery performed in advanced pregnancy compared to early pregnancy. Arch Gynecol Obstet. 2015;292(5):1063-8. doi: 10.1007/s00404-015-3744-8.
Guterman S, Mandelbrot L, Keita H, Bretagnol F, Calabrese D, Msika S. Laparoscopy in the second and third trimesters of pregnancy for abdominal surgical emergencies. J Gynecol Obstet Hum Reprod. 2017;46(5):417-422. doi: 10.1016/j.jogoh.2017.03.008.
Upadhyay A, Stanten S, Kazantsev G, Horoupian R, Stanten A. Laparoscopic management of a nonobstetric emergency in the third trimester of pregnancy. Surg Endosc. 2007;21(8):1344-8. doi: 10.1007/s00464-006-9104-9
Cohen SB, Watad H, Shapira M, Goldenberg M, Mashiach R. Urgent Laparoscopic Surgeries during the Third Trimester of Pregnancy: A Case Series. J Minim Invasive Gynecol. 2020;27(4):909-914. doi: 10.1016/j.jmig.2019.06.015.
Bustamante Bozzo R, Lacassie Quiroga H. Manejo anestésico de la paciente de urgencia embarazada. Revista Chilena de Anestesia. 2020;50(1):171-195. doi: 10.25237/revchilanestv50n01-11
Dhupar R, Smaldone GM, Hamad GG. Is there a benefit to delaying cholecystectomy for symptomatic gallbladder disease during pregnancy? Surg Endosc. 2010;24(1):108-12. doi: 10.1007/s00464-009-0544-x.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles, videos and images published in Revista Cirugía del Uruguay are under the Creative Commons CC licenses, which is a complement to the traditional copyright, in the following terms: first, the authorship of the referred document must always be acknowledged and secondly none of the article or work published in the journal may have commercial purposes of any nature. The authors retain their copyrights and give the magazine the right of first publication of their work, which will be simultaneously subject to the Creative Commons Attribution-NonCommercial 4.0 International License license that allows the work to be shared whenever the initial publication is indicated in this journal.
