THE EFFICIENCY OF LAPAROSCOPIC SURGERY FOR WOMEN HOSPITALIZED WITH ACUTE CHOLECYSTITIS AT DIFFERENT STAGES OF PREGNANCY.
Main Article Content
Keywords
complicated gallstones, pregnant women, fetal and maternal problems, endoscopic retrograde cholangiopancreatography
Abstract
Background: Gallstones are detected in 1–3% of pregnancies, and 0.05–8% of cases result in biliary disease symptoms. It is thought that progesterone and estrogen cause bile to have higher amounts of cholesterol, which can contribute to the formation of gallstones during pregnancy. Acute appendicitis is the most common cause of non-obstetric abdominal surgical complications during pregnancy, with acute cholecystitis coming in second. Choosing conservative therapies carries hazards for the fetus as well as the mother. Approximately 27–36% of people with symptomatic biliary illness may still need surgery after receiving medical care.
Objective: To evaluate the efficiency of laparoscopic surgery for women hospitalized with acute cholecystitis at different stages of pregnancy.
Study design: An analytical cross-sectional study
Place and Duration: This study was conducted in Muhammad Medical and Dental College Mirpurkhas from September 2022 to September 2023.
Methodology: A total of 30 women were included in this research. All of the participants were pregnant women diagnosed with acute cholecystitis. The gathered data included demographics, gestational age, symptoms, clinical and physical examination, maternal and fetal complications, radiological findings, number of pregnancies, treatment, diagnosis, frequency of hospital admissions, and time period of stay in hospital. Some of the things that were looked into before and during surgery were the abdominal entrance technique and the use of endoscopic retrograde cholangiopancreatography (ERCP).
Results: A total of 30 pregnant women were involved in this research. All of these participants had complicated gallstone diseases like cholangitis, choledocholithiasis, and acute cholecystitis. The patients were divided into two groups. Group A was the immediate surgery group, which included a total of 9 patients. Group B was the conservative management and delayed surgery group, which included a total of 21 patients. The participant’s mean age was 29.5 years. The mean gestational period at the time of diagnosis was 20 weeks.
Conclusion: Managing complicated gallstone diseases during pregnancy presents a difficult problem because of the increased rates of fetal and maternal problems.
References
2. Cheng V, Matsushima K, Sandhu K, Ashbrook M, Matsuo K, Inaba K, Demetriades D. Surgical trends in the management of acute cholecystitis during pregnancy. Surgical Endoscopy. 2021 Oct;35:5752-9.
3. ELAMIN ALI, M. YAHIA AL-SHEHRI, S. ABU-ESHY, MA CHEEMA, Z. MUSTAFA and A. SADEK M. Is surgical intervention in acute cholecystitis in pregnancy justified?. Journal of Obstetrics and Gynaecology. 1997 Jan 1;17(5):435-8.
4. Tseng JY, Yang MJ, Yang CC, Chao KC, Li HY. Acute cholecystitis during pregnancy: what is the best approach?. Taiwanese Journal of Obstetrics and Gynecology. 2009 Sep 1;48(3):305-7.
5. Rios-Diaz AJ, Oliver EA, Bevilacqua LA, Metcalfe D, Yeo CJ, Berghella V, Palazzo F. Is it safe to manage acute cholecystitis nonoperatively during pregnancy?: A nationwide analysis of morbidity according to management strategy. Annals of Surgery. 2020 Sep 1;272(3):449-56.
6. Allmendinger N, Hallisey MJ, Ohki SK, Straub JJ. Percutaneous cholecystostomy treatment of acute cholecystitis in pregnancy. Obstetrics & Gynecology. 1995 Oct 1;86(4):653-4.
7. Ilhan G, Gök AF, Günay K, Ertekin C. The course and outcomes of complicated gallstone disease in pregnancy: Experience of a tertiary center.
8. Landers D, Carmona R, Crombleholme W, Lim R. Acute cholecystitis in pregnancy. Obstetrics & Gynecology. 1987 Jan 1;69(1):131-3.
9. Caliskan K. The use of percutaneous cholecystostomy in the treatment of acute cholecystitis during pregnancy. Clinical and experimental obstetrics & gynecology. 2017 Feb 10;44(1):11-3.
10. Kammerer WS. Nonobstetric surgery in pregnancy. Med Clin North Am 1987;71:551–60.
11. Saunders P, Milton PJ. Laparotomy during pregnancy: an assessment of diagnostic accuracy and fetal wastage. Br Med J 1973;3:165–7.
12. Hiatt JR, Hiatt JC, Williams RA, Klein SR. Biliary disease in pregnancy: strategy for surgical management. Am J Surg 1986;151:263–5.
13. Date RS, Kaushal M, Ramesh A. A review of the management of gallstone disease and its complications in pregnancy. Am J Surg 2008;196:599– 608.
14. Jelin EB, Smink DS, Vernon AH, Brooks DC. Management of biliary tract disease during pregnancy: a decision analysis. Surg Endosc 2008;22:54–60.
15. Tuech JJ, Binelli C, Aube C, Pessaux P, Fauvet R, Descamps P, et al. Management of choledocholithiasis during pregnancy by magnetic resonance cholangiography and laparoscopic common bile duct stone extraction. Surg Laparosc Endosc Percutan Tech 2000;10:323–5.
16. Othman MO, Stone E, Hashimi M, Parasher G. Conservative management of cholelithiasis and its complications in pregnancy is associated with recurrent symptoms and more emergency department visits. Gastrointest Endosc 2012;76:564–9.
17. Maringhini A, Ciambra M, Baccelliere P, Raimondo M, Orlando A, Tinè F, et al. Biliary sludge and gallstones in pregnancy: incidence, risk factors, and natural history. Ann Intern Med 1993;119:116–20
18. Cosenza CA, Saffari B, Jabbour N, Stain SC, Garry D, Parekh D, et al. Surgical management of biliary gallstone disease during pregnancy. Am J Surg 1999;178:545–8.
19. Veerappan A, Gawron AJ, Soper NJ, Keswani RN. Delaying cholecystectomy for complicated gallstone disease in pregnancy is associated with recurrent postpartum symptoms. J Gastrointest Surg 2013;17:1953–9.
20. Dixon NP, Faddis DM, Silberman H. Aggressive management of cholecystitis during pregnancy. Am J Surg 1987;154:292–4
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Allah Bachayo Rajar
Professor Community Medicine, Muhammad Medical and Dental College Mirpurkhas Pakistan.
Imam Bakhsh
Associate Professor General Surgery, Mekran Medical College Turbat Balochistan Pakistan.
Abdul Rehman
Assistant Professor Anatomy, Bhitai Dental and Medical College Mirpurkhas Pakistan.
Shah Nawaz Khatti
Assistant Professor General Surgery, Liaquat University of Medical and Health Sciences Jamshoro Pakistan
Abdul Rahim
Registrar and Consultant General Surgeon, Peoples University of Medical and Health Sciences Nawabshah Pakistan.
Imtiaz Ali Langah
Assistant Professor General Surgery, Peoples University of Medical and Health Sciences Nawabshah Pakistan.