Minimally invasive management of acute biliary tract disease during pregnancy.

Luis Tomás Chiappetta Porras,Eduardo Daniel Nápoli,Juan Alvarez Rodríguez,Alejandro Salvador Oría,Bernabé Matías Quesada,Hernán Eduardo Roff,Carlos Manuel Canullán

doi:10.1155/2009/829020

Abstract

Background. Acute biliary diseases during pregnancy have been classically managed conservatively. Advances in minimally invasive surgery and the high recurrence rate of symptoms observed changed this management. Methods. This is a prospective observational study. Initial management was medical. Unresponsive patients were treated with minimally invasive techniques including gallbladder percutaneous aspiration or cholecystostomy, endoscopic retrograde cholangiography, and laparoscopic cholecystectomy, depending on the pregnancy trimester and underlying diagnosis. Results. 122 patients were admitted. 69 (56.5%) were unresponsive to medical treatment. Recurrent gallbladder colic was the most frequent indication for minimally invasive intervention, followed by acute cholecystitis, choledocholithiasis, and acute biliary pancreatitis. 8 patients were treated during the first trimester, 54 during the second, and 7 during the last trimester. There was no fetal morbidity or mortality. Maternal morbidity was minor with no mortality. Conclusion. Acute biliary tract diseases during pregnancy may be safely treated with minimally invasive procedures according to the underlying diagnosis and to the trimester of pregnancy.

Highlights

Symptomatic biliary tract disease during pregnancy has been traditionally managed conservatively, leaving surgery for treatment failures
Admission diagnoses were recurrent gallbladder colic in 55 cases, acute cholecystitis in 41, bile duct obstruction in 18, and acute biliary pancreatitis in 8.75% of patients were admitted initially at our hospital and 25% were referred from other institutions
Conservative treatment failure occurred in 69 patients (56.5%). 8 patients were treated during the first trimester of pregnancy of whom 4 with acute cholecystitis were treated with percutaneous cholecystostomy, 3 admitted because of recurrent gallbladder colics were treated with percutaneous gallbladder aspiration with symptomatic relief in all of them and one patient with acute biliary pancreatitis was treated with endoscopic retrograde cholangiography (ERCP) removing 2 bile duct stones. 54 patients were admitted during the second trimester of pregnancy and were treated with laparoscopic surgery

Summary

Introduction

Symptomatic biliary tract disease during pregnancy has been traditionally managed conservatively, leaving surgery for treatment failures. A recent report suggests that fetal death rate is higher after conservative treatment than after laparoscopic cholecystectomy for symptomatic benign biliary disease [1]. The objective of this study is to analyze the results obtained with a minimally invasive protocol to treat patients with acute biliary tract disease during pregnancy. Advances in minimally invasive surgery and the high recurrence rate of symptoms observed changed this management. Unresponsive patients were treated with minimally invasive techniques including gallbladder percutaneous aspiration or cholecystostomy, endoscopic retrograde cholangiography, and laparoscopic cholecystectomy, depending on the pregnancy trimester and underlying diagnosis. Acute biliary tract diseases during pregnancy may be safely treated with minimally invasive procedures according to the underlying diagnosis and to the trimester of pregnancy

Objectives

Methods

Results

Conclusion