Table of Contents
HPB Surgery
Volume 2009, Article ID 829020, 3 pages
http://dx.doi.org/10.1155/2009/829020
Clinical Study

Minimally Invasive Management of Acute Biliary Tract Disease during Pregnancy

1Department of Surgery, “Cosme Argerich” Hospital, Almirante Brown 240, Buenos Aires 1155 , Argentina
2University of Buenos Aires, Paraguay 2155, Buenos Aires 1121, Argentina

Received 22 October 2008; Revised 9 April 2009; Accepted 17 May 2009

Academic Editor: Guy Maddern

Copyright © 2009 Luis Tomás Chiappetta Porras et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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. Conclusion. 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.