Cholelithiasis in pregnancy: surgical versus medical management

Objective: To compare surgical versus medical management of symptomatic biliary disease in pregnancy. Methods: An 8-year retrospective review was conducted of patients hospitalized for symptomatic gallbladder disease in pregnancy. Results: Thirty-five pregnant patients were hospitalized for symptomatic biliary disease (19 biliary colic, 8 acute cholecystitis, 7 choledocholithiasis, and 1 gallstone pancreatitis). Patients were managed according to obstetrician preference. Those managed surgically tended to have more advanced disease, as demonstrated by increased elevation in their liver transaminase (110.5 ± 123.5 versus 49.6 ± 32, P = 0.02). In the medically managed group (n = 20), there was one maternal death due to lethal cardiac arrhythmia and one fetal death due to meconium aspiration syndrome at term. There were no maternal or fetal deaths in the surgically managed group (n = 15). The following table compares pregnancy outcome. Conclusions: In our study, surgical management resulted in better pregnancy outcomes and should be considered for all pregnant patients with symptomatic biliary disease severe enough to warrant hospitalization. legend. OutcomelegendMedical managementSurgical managementP valuePremature labor7/20 (35%)2/15 (13%)0.25Meconium at delivery9/19 (47%)1/15 (7%)0.035Infant < 2,500 g6/19 (31%)1/15 (7%)0.008NICU admissions11/19 (58%)2/15 (13%)0.008legendNICU indicates neonatal intensive care unit. legend. NICU indicates neonatal intensive care unit.