Minimally invasive management of acute biliary tract disease during pregnancy.
BACKGROUND
Acute biliary diseases during pregnancy have been classically managed conservatively. Advances in minimally invasive surgery and the high recurrence rate of symptoms observed changed this management.


METHODS
This is a prospective observational study. Initial management was medical. Unresponsive patients were treated with minimally invasive techniques including gallbladder percutaneous aspiration or cholecystostomy, endoscopic retrograde cholangiography, and laparoscopic cholecystectomy, depending on the pregnancy trimester and underlying diagnosis.


RESULTS
122 patients were admitted. 69 (56.5%) were unresponsive to medical treatment. Recurrent gallbladder colic was the most frequent indication for minimally invasive intervention, followed by acute cholecystitis, choledocholithiasis, and acute biliary pancreatitis. 8 patients were treated during the first trimester, 54 during the second, and 7 during the last trimester. There was no fetal morbidity or mortality. Maternal morbidity was minor with no mortality.


CONCLUSIONS
Acute biliary tract diseases during pregnancy may be safely treated with minimally invasive procedures according to the underlying diagnosis and to the trimester of pregnancy.
Chiappetta Porras
Luis Tomás
LT
Department of Surgery, Cosme Argerich Hospital, Almirante Brown 240, Buenos Aires 1155, Argentina.
Nápoli
Eduardo Daniel
ED
Canullán
Carlos Manuel
CM
Quesada
Bernabé Matías
BM
Roff
Hernán Eduardo
HE
Alvarez Rodríguez
Juan
J
Oría
Alejandro Salvador
AS
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult