title: Delaying cholecystectomy for complicated gallstone disease in pregnancy is associated with recurrent postpartum symptoms.
abstract: BACKGROUND
  Pregnancy is a risk factor for gallstone disease; in some patients, cholecystectomy may be delayed to the postpartum period. Our aim was to examine the effect of antepartum interventions on postpartum outcomes in complicated gallstone disease (CGD) during pregnancy.
  
  
  METHODS
  Retrospective analysis of patients seeking medical care for CGD (cholecystitis, choledocholithiasis, or gallstone pancreatitis) during pregnancy at a single tertiary care institution over a 10-year period (2002-2012). Patients were contacted via standardized telephone survey to account for outside hospitalizations.
  
  
  CONCLUSIONS
  We identified 56 patients with CGD during pregnancy, 42.9 % initially presenting during the second trimester. Choledocholithiasis was the most common diagnosis (n = 30). Antepartum cholecystectomy was performed in 17.9 %. Seventeen patients did not follow up postpartum and did not complete telephone survey. Of the remaining 29 patients, 58.6 % had recurrent postpartum symptoms, 35.3 % recurred within 1 month, and 82.4 % within 3 months of delivery. Antepartum ERCP with biliary sphincterotomy decreased postpartum symptom recurrence (38.5 vs. 75.0 %, p = 0.07).
  
  
  CONCLUSIONS
  The majority of patients with CGD who do not undergo antepartum cholecystectomy have recurrent postpartum symptoms often within 3 months postpartum. When appropriate, physicians should advocate for antepartum or early postpartum cholecystectomy to minimize symptom recurrence and unplanned hospitalizations.
authors.affiliation: Department of Medicine, Division of Gastroenterology & Hepatology, Feinberg School of Medicine, NMH/Arkes Family Pavilion Suite 1400, 676 N Saint Clair, Chicago, IL, 60611, USA.
authors.forename: Annapoorani
authors.initials: A
authors.lastname: Veerappan
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gawron
authors.forename: Nathaniel J
authors.initials: NJ
authors.lastname: Soper
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Keswani
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000209:etiology / Q000601:surgery*; D042883:Choledocholithiasis / Q000150:complications / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D006801:Humans; D010195:Pancreatitis / Q000209:etiology; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D011295:Prenatal Care; D012008:Recurrence; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D013997:Time Factors; D055815:Young Adult