Changing management of gallstone-related disease in pregnancy - a retrospective cohort analysis

Objectives: Gallstone-related disease is the second most common non-obstetric cause, following appendicitis, for acute abdomen in pregnancy. This study aimed to investigate treatment strategies, changes over time and outcome.Materials and methods: All consecutive patients with symptomatic gallstone-related disease during pregnancy admitted to Skane University hospital in Lund and Malmo 2001-2015 were analysed retrospectively. Information regarding the patient, pregnancy and fetus/child was recorded. The material was analysed by dividing it into two equal time periods and by comparing conservative management and surgical intervention.Results: We included 96 patients with 97 pregnancies. The age was 30 (26-34) years and BMI 28 (24-31). Median length of pregnancy at first admission was 23 (13-31) weeks. The three most common diagnoses were biliary colic (n=63), cholecystitis (n=22) and acute pancreatitis (n=16). Conservative treatment was practiced in 62 (64%) patients and intervention in 35 (36%). Conservatively treated patients were admitted later during pregnancy (week 26 (20-33) versus 17 (10-22), p<.001). Surgically treated patients had a longer total length of stay (all admissions) than conservatively treated patients (p=.001), less readmissions (p=.001) and equal birth outcome. Surgical intervention was more common in the later time period (48% versus 22%, p=.011). Of the conservatively treated patients, 56% were subjected to surgical intervention within 2 years after delivery.Conclusions: We found that intervention was more common in the later time period, with good results concerning safety, and less readmissions. A majority of the conservatively treated patients had surgical intervention within two years after delivery. Our results support surgical intervention in pregnancy.