Hassanesfahani Maryam, Villavarajan Brithica, Otusile Ibironke, Williams Benjamin Seth, Tian Jane, Miele Andrew, Louis Martine A, Mandava Nageswara
Flushing Hospital Medical Center, Department of General Surgery, New York, NY, USA.
St. George's University, New York, NY, USA.
Langenbecks Arch Surg. 2025 Jul 3;410(1):211. doi: 10.1007/s00423-025-03768-8.
Gallbladder disease is the primary non-obstetrical cause of hospitalization during pregnancy. The hormonal milieu changes with elevated estrogen and progesterone, reducing gallbladder contraction, promoting biliary stasis, and increasing cholesterol stone formation. This eventually causes biliary colic and acute cholecystitis. Both SAGES and ACOG consider laparoscopic cholecystectomy safe in all trimesters. We present a case series of gallbladder disease presenting during pregnancy comparing outcomes of patients who underwent Non-Operative Management (NOM) and those who received surgery.
A 10-year retrospective electronic medical records review of pregnant patients between October 2012- December 2022, with the diagnosis of gallbladder disease. Data collection included patient characteristics, clinical presentation, lab values, imaging, treatment modalities, and outcomes. Fischer's exact test was used to determine statistical significance.
A total of 228 pregnant patients presented with gallbladder disease; 8 underwent OM, with indications of failed NOM secondary to intractable pain, with no complications. Of 220 managed conservatively, 77% experienced recurrence, and most underwent elective surgery postpartum. No maternal-fetal complications occurred in either group, though NOM was associated with high recurrence and readmission rates.
Despite current guidelines recommending surgical intervention, our study reveals that non-operative management remains the predominant approach in real-world practice. While it is associated with a high rate of symptom recurrence and postpartum readmissions, fetal outcomes remain favorable in patients managed conservatively. These findings underscore the need for updated guidelines that reflect evolving clinical trends and emphasize individualized patient care.
胆囊疾病是孕期非产科住院的主要原因。随着雌激素和孕激素水平升高，激素环境发生变化，胆囊收缩减弱，胆汁淤积加重，胆固醇结石形成增加。这最终会导致胆绞痛和急性胆囊炎。美国胃肠内镜外科医师学会（SAGES）和美国妇产科医师学会（ACOG）均认为腹腔镜胆囊切除术在孕期各阶段都是安全的。我们呈现了一组孕期胆囊疾病病例系列，比较了接受非手术治疗（NOM）和接受手术治疗的患者的结局。
对2012年10月至2022年12月期间诊断为胆囊疾病的孕妇进行了为期10年的回顾性电子病历审查。数据收集包括患者特征、临床表现、实验室检查值、影像学检查、治疗方式和结局。采用Fisher精确检验确定统计学意义。
共有228例孕妇患有胆囊疾病；8例接受了手术治疗，指征为因顽固性疼痛导致非手术治疗失败，且无并发症。在220例接受保守治疗的患者中，77%出现复发，大多数患者在产后接受了择期手术。两组均未发生母婴并发症，尽管非手术治疗与高复发率和再入院率相关。
尽管目前的指南推荐手术干预，但我们的研究表明，在实际临床实践中，非手术治疗仍然是主要的治疗方法。虽然它与高症状复发率和产后再入院率相关，但保守治疗患者的胎儿结局仍然良好。这些发现强调需要更新指南，以反映不断变化的临床趋势，并强调个体化的患者护理。
