Medical versus surgical management of biliary tract disease in pregnancy.
BACKGROUND
The management of symptomatic cholelithiasis during pregnancy remains controversial. We compared outcomes after medical versus surgical management of biliary tract disease in pregnant patients.


METHODS
We reviewed the clinical course of patients with symptomatic cholelithiasis during pregnancy from 1992 to 2002 at two university hospitals.


RESULTS
Seventy-six women with 78 pregnancies were admitted with biliary tract disease. Of the 63 women who presented with symptomatic cholelithiasis, 10 underwent surgery while pregnant. There were no deaths, preterm deliveries, or intensive care unit admissions. Fifty-three patients were treated medically. Their clinical courses were complicated by symptomatic relapse in 20 patients (38%), by labor induction to control biliary colic (8 patients), and by premature delivery in 2 patients. Each relapse in the medically managed group accounted for an additional five days in hospital.


CONCLUSIONS
Surgical management of symptomatic cholelithiasis in pregnancy is safe, decreases days in hospital, and reduces the rate of labor induction and preterm deliveries.
Lu
Erika J
EJ
Department of Surgery, University of California-San Francisco, 533 Parnassus Avenue, Room U-372, San Francisco, CA 94143-0790, USA.
Curet
Myriam J
MJ
El-Sayed
Yasser Y
YY
Kirkwood
Kimberly S
KS
D000328:Adult; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D002764:Cholecystitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal