Cholecystectomy and ERCP in pregnancy: a nationwide register-based study.

OBJECTIVE: The objective was to examine the outcomes of cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy and compare these outcomes with those in nonpregnant women of fertile age. SUMMARY BACKGROUND DATA: Although both laparoscopic cholecystectomy and ERCP are considered safe and feasible in pregnant patients, there is still concern and uncertainty regarding gallstone intervention during pregnancy. This study aimed to investigate outcomes in pregnant patients compared to outcomes in nonpregnant patients. METHODS: Data on all female patients aged 18-45 years were retrieved from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The patients were divided into groups according to intervention: cholecystectomy, ERCP, or a combination thereof. Differences between pregnant and nonpregnant patients were analyzed. RESULTS: A total of 21 328 patients were included, with 291 cholecystectomy and 63 ERCP procedures performed in pregnant patients. At the 30-day follow-up, more complications after cholecystectomy were registered for pregnant patients. However, pregnancy was not a significant risk factor for adverse events when adjusting for previous complicated gallstone disease, intraoperative complications, emergency surgery, and common bile duct stones. There were no differences in outcomes when comparing cholecystectomy among the different trimesters. ERCP had no significant effect on outcomes at the 30-day follow-up. CONCLUSION: Cholecystectomy, ERCP, and combinations thereof are safe during pregnancy.

Surgery A survey of patients' perceptions and experiences of intervention for gallstone disease during pregnancy.

Background: Gallstones intervention during pregnancy might be a stressful event for both mother and fetus and stress might affect outcome. The aim of this study was to identify factors that might improve the care of pregnant patients in need of intervention for gallstone disease. Methods: By crossmatching the Swedish Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Medical Birth Registry, we identified patients with gallstone intervention during pregnancy. A questionnaire covering patient experience before, during and after surgery and the Beck Depression Inventory II (BDI-II) were distributed. Results: In total, 275 patients subjected to cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) or both were identified, and 146 (54%) patients responded. Surgery was in median performed in pregnancy week 16 (12-20), and 62 (42%) patients had symptoms of gallstone disease before pregnancy, with 17 of these patients scheduled for surgery before pregnancy. Thirty-four (24%) patients felt that the information regarding the upcoming surgery was inadequate, with differences comparing patients with overall favorable versus overall non-favorable experiences (103 (89%) vs. 8 (27%) p < 0.001) and similar differences regarding information on disease/symptoms (95 (84%) vs. 12 (43%), p < 0.001). A majority (57%) were very worried about their expected child, and 51% thought that no measures were taken to relieve their worries. Recurring as suggested improvements was more information about the disease and the surgical procedure. Conclusion: Intervention due to gallstone disease during pregnancy is a stressful event that impacts many patients negatively, both before and after surgery. Patient education might positively affect patient experience.

Cholecystectomy After Previous Bariatric Surgery with Special Focus on Pregnant Patients-Results from Two Large Nationwide Registries.

BACKGROUND: Biliary complications during pregnancy is an important issue. The aim of this study was to examine if there is an increased risk to perform cholecystectomy during pregnancy in patients with previous bariatric surgery in comparison to other females subjected to cholecystectomy. METHODS: The Nationwide Swedish Registry for Gallstone Surgery (GallRiks) and the Scandinavian Obesity Surgery Registry (SOReg) were combined. Female patients 18-45 years old were included. The study group was patients with a history of bariatric surgery whom were pregnant at the time of cholecystectomy. This group was compared with pregnant patients without previous bariatric surgery and non-pregnant with and without previous bariatric surgery. RESULTS: In total, 21,314 patients were included and 292 underwent surgery during pregnancy. From 1282 patients identified in both registers, 16 patients were pregnant at the time of cholecystectomy. Acute cholecystectomy was performed in 5922 (28%) non-pregnant and 199 (68%) pregnant (p < 0.001), including 11/16 (69%) pregnant with previous bariatric surgery. When comparing all pregnant patients, those with previous bariatric surgery had longer operative time (p = 0.031) and length of stay (p = 0.043), but no differences were seen when only comparing patients with an acute indication for surgery. There was no difference in complications comparing pregnant patients with previous bariatric surgery with non-pregnant, both with and without previous bariatric surgery. CONCLUSIONS: Cholecystectomy during pregnancy in patients with previous bariatric surgery seems to be safe. The increased risk seen in the non-pregnant group after previous bariatric surgery is not seen in pregnancy, possibly due to an optimization of the circumstances at surgery.