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Gallbladder Removal During Pregnancy – The Debate

Gallbladder Removal During Pregnancy – The Debate

Surgery is always a calculated risk but imagine needing surgery while you are pregnant. This adds an entirely new wrinkle to the problem. This theory becomes reality to hundreds of women every year and in this article, we will look at the complicated decision of choosing or not choosing gallbladder surgery.

Data shows that pregnant women produce a higher level or concentration of progesterone. This, in turn, can increase the women’s risk factors for developing gallstones. In some cases, gallstones lead to Gallbladder Complications and require surgery.

Pain is one of the primary symptoms that a woman might develop that indicates a need for surgery, though there are other symptoms as well. Gallbladder attacks can happen to men and women and can happen during or without pregnancy.  However, the risk for maternal complications can be seen during pregnancy and it is important for all pregnant women to know about the increased risks for gallstones and the risks associated with surgery.

The surgical intervention is called a Cholecystectomy where the Gallbladder is removed. It is often done laparoscopically but can require an open surgical procedure.

As you will see below, there is differing opinion on whether you should have surgery while you are Pregnant. The following information is to allow you to look at both sides objectively.

The Decision – Conflicting Information

Some patients may be given the opportunity to decide whether to have surgery during their pregnancy or wait until after Childbirth. In these types of cases, there are typically minimal risks, no infections, and minimal gallbladder wall thickening. In severe cases, surgery may be an emergency and life-saving procedure.

It is natural to assume that if you were put into the position that you would choose to wait, however, the pain, complications, vomiting, and other symptoms may change your mind. It is hard to know what decision you will make until you are put into that position.

Choosing to wait to have Surgery

“Current guidelines recommend surgery for acute cholecystitis during pregnancy, but many patients and providers delay surgery,” said researcher Dr. Francesco Palazzo, vice-chair of surgery at Thomas Jefferson University Hospital, in Philadelphia.

Waiting could result in the following complications:  Stillbirth, Premature Birth, Poor fetal growth, C-section, Bleeding, Blood Clots, Infections, and more.

Dr. Palazzo performed a research study looking into nearly 6,500 pregnant women admitted to a hospital for cholecystitis (Inflammation of the Gallbladder) between 2010 and 2015. Less than 40% of the women had surgery to remove their gallbladder while pregnant. And…pregnant women who did not have surgery were three times more likely to have complications at the birth of their child.

According to researcher Dr. Arturo Rios-Diaz, a surgical resident, “The data doesn’t tell us exactly why these complications occurred, just that they were more common in women whose surgeries were delayed after accounting for differences between the groups.”

Also, women who didn’t have the surgery during pregnancy were 61% more likely to be readmitted to the hospital within 30 days of discharge, and 95% more likely to be readmitted with a complication, the researchers noted.

These data show that there are risks with waiting out the surgery, the researchers explained. The report was published online in the journal Annals of Surgery.

Choosing to have Surgery

Women who have their gallbladder removed during pregnancy are more likely to experience longer hospital stays, increased 30-day readmissions, and higher rates of preterm delivery than those who delay the operation until after childbirth, according to the study results published online as an “article in press” on the Journal of the American College of Surgeons website.

“In light of these findings, whenever possible, women with symptomatic gallstones in pregnancy should wait as long as possible to let the baby mature before having the cholecystectomy,” said study coauthor Henry A. Pitt, MD, FACS, professor of surgery at Temple University School of Medicine, Philadelphia.

Dr. Pitt and colleagues studied a large database of women in California (the California Office of Statewide Health Planning and Development database) who underwent a laparoscopic or open cholecystectomy between 2005 and 2014 for gallstones or other benign biliary disease. They compared 403 pregnant women who underwent the operation within 90 days prior to childbirth with 17,490 women who had the procedure within three months after childbirth.

“One important finding was that maternal delivery outcomes — including eclampsia and hemorrhage for the mother, and preterm delivery — were significantly worse when the cholecystectomy was done during pregnancy as opposed to postpartum,” Dr. Pitt said.

References

Delaying gallbladder surgery raises risk of complications:  https://www.upi.com/Health_News/2019/10/31/Delaying-gallbladder-surgery-raises-risk-of-complications/9791572532606/

Gallbladder removal operation during pregnancy associated with adverse maternal outcomes: https://www.sciencedaily.com/releases/2019/02/190212134759.htm

Is It Safe to Manage Acute Cholecystitis Nonoperatively During Pregnancy?: A Nationwide Analysis of Morbidity According to Management Strategy

Gallbladder Removal Operation During Pregnancy Associated with Adverse Maternal Outcomes, Longer Hospital Stays, and Higher Hospital Costs