Surgical considerations in the contemporary management of biliary tract disease in the postpartum period.
BACKGROUND
Excluding sterilization procedures, no experience with laparoscopic procedures in the postpartum period has been reported. The postpartum patient may have unique characteristics that must be recognized for safe management.


METHODS
The authors prospectively studied 1,100 consecutive biliary patients in a private surgical practice since the introduction of laparoscopic cholecystectomy (LC). The group includes 34 patients who presented with biliary tract disease and were operated upon within 6 weeks of obstetrical delivery. Laparoscopic procedures were performed on these 34 patients 1 to 42 days following vaginal (26) or Cesarean (8) deliveries.


RESULTS
All patients had calculous cholecystitis. Choledocholithiasis was documented in 10 (29%) patients, including 3 patients (9%) with missed common duct stones, and strongly suggested in 5 (15%) others. Open biliary procedures were required for 2 patients. One patient returned to surgery for an ERCP-related complication. Follow up is known for all patients. There were no delayed complications.


CONCLUSIONS
The laparoscopic approach to biliary tract disease in the postpartum period is safe. Recent vertical Cesarean incisions can withstand the strain of a reduced pneumoperitoneum. The high incidence of choledocholithiasis calls for routine cholangiography in the postpartum patient.
Department of Surgery, Illinois Masonic Medical Center, Chicago, USA.
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Diettrich
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Kaplan
D000293:Adolescent; D000328:Adult; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D036861:Delivery, Obstetric; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D011028:Pneumoperitoneum, Artificial / Q000379:methods; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies