title: Laparoscopic cholecystectomy and interventional endoscopy for gallstone complications during pregnancy.
abstract: BACKGROUND
  Symptomatic or complicated gallstone disease is the most common reason for nongynecological operations during pregnancy. Gallstones are present in 12% of all pregnancies, and more than one-third of patients fail medical treatment and therefore require surgical endoscopy or laparoscopy. Gallstone pancreatitis and jaundice during pregnancy is associated with a high recurrence rate, exposing both fetus and mother to an increased risk of morbidity and mortality.
  
  
  METHODS
  During a 4-year period, all pregnant patients (n = 37) with symptomatic or complicated gallstone disease were studied prospectively at the Landeskrankenhaus in Salzburg, Austria. Five patients had an endoscopic retrograde cholangiopancreatogram (ERCP) for biliary pancreatitis or jaundice; two of these underwent subsequent laparoscopic cholecystectomy. Another seven patients required laparoscopic cholecystectomy for severe pain or cholecystitis; all were in their 13th-32nd gestational week. Access was established by Veress needle in all cases. Insufflation pressure was 8-10 mm Hg, and mean operative time was 62 min.
  
  
  RESULTS
  All patients delivered full-term, healthy babies. There were no postendoscopic or postoperative complications. All patients enjoyed full relief from their symptoms; there were no recurrences of pancreatitis or jaundice.
  
  
  CONCLUSIONS
  The combination of ERCP and laparoscopic cholecystectomy offers a safe and effective option for the definitive treatment of complicated gallstone disease and intractable pain during pregnancy, and there is sufficient access for the combined treatment to be employed.
authors.affiliation: I. Chirurgische Abteilung und Ludwig-Boltzmann-Institut für experimentelle und gastroenterologische Chirurgie, Landeskliniken Salzburg, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Sungler
authors.forename: P M
authors.initials: PM
authors.lastname: Heinerman
authors.forename: H
authors.initials: H
authors.lastname: Steiner
authors.forename: H W
authors.initials: HW
authors.lastname: Waclawiczek
authors.forename: J
authors.initials: J
authors.lastname: Holzinger
authors.forename: F
authors.initials: F
authors.lastname: Mayer
authors.forename: A
authors.initials: A
authors.lastname: Heuberger
authors.forename: O
authors.initials: O
authors.lastname: Boeckl
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011256:Pregnancy Outcome; D011446:Prospective Studies