Laparoscopic cholecystectomy in pregnancy: An Australian retrospective cohort study.

INTRODUCTION

Biliary tract disease is a common non-obstetric surgical presentation during pregnancy. Although small international series demonstrate favourable outcomes following laparoscopic cholecystectomy (LC) during pregnancy, there is a paucity of Australian data to complement these findings.

METHOD

Between 1st January 2003 and 30th June 2013, all patients undergoing planned LC during pregnancy at Western Health were retrospectively identified.

RESULTS

Twenty-two patients underwent planned LC with 3 (13%) cases converted to open surgery. The median maternal age was 31 years (27.8-36) with an estimated median gestational age (EGA) of 19.5 weeks (16.5-23.5). Eighteen (82%) cases were performed during the second trimester. Nine (40%) patients had 2 or more hospital admissions for similar presentations. Twelve (54%) were performed as index cases. Operative indications included 12 (54%) with recurrent biliary colic, five (22%) with acute cholecystitis and 3 (14%) with gallstone pancreatitis. Median operating time for completed LCs was 65 min (60-95). Intra-operative cholangiogram was performed in seven (32%) cases, 5 (71%) of which employed protective uterine lead shielding. There was no fetal loss or uterine injury. Median hospital stay was 3 days (2-7) for completed LCs. Major morbidity occurred in 2 (10%) completed LCs that required a return to theatre. Five (23%) births were lost to follow up. The median time to delivery post-surgery was 13 weeks (11-15). Two (12%) preterm deliveries occurred, with subsequent neonatal complications.

CONCLUSION

Antenatal laparoscopic cholecystectomy demonstrated comparably safe outcomes. Increasing its utilization to manage symptomatic cholelithiasis during pregnancy may be considered.