Management strategies for acute cholecystitis in late pregnancy: a multicenter retrospective study

Wei Zhang; Huiming Yi; Ming Cai; Jian Zhang

doi:10.1186/s12893-023-02257-3

Management strategies for acute cholecystitis in late pregnancy: a multicenter retrospective study

BMC Surg. 2023 Nov 10;23(1):340. doi: 10.1186/s12893-023-02257-3.

Authors

Wei Zhang¹, Huiming Yi¹, Ming Cai², Jian Zhang³

Affiliations

¹ Department of Medical Ultrasound, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, China.
² Department of Hepatobiliary Pancreatic Surgery, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, China.
³ Department of Hepatobiliary Pancreatic Surgery, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, China. hustzj1984@hust.edu.cn.

Abstract

Objective: This study aims to investigate the management strategies for acute cholecystitis in the third trimester of pregnancy by comparing the effectiveness of three different treatments.

Methods: Clinical data of 102 patients with acute cholecystitis in third trimester of pregnancy admitted to three Tertiary Hospitals from January 2010 to June 2020 were collected and divided into 3 groups according to the primary treatment during their first hospitalization: Group A (surgical group; n = 11), Group B (percutaneous transhepatic gallbladder drainage (PTGD) group, n = 29) and Group C (conservative treatment group, n = 62). The length of stay, readmission rate, and preterm delivery rate of each group were analyzed retrospectively.

Results: The average age of patients included in this study was 29 ± 2.16 years with an average gestational cycle of 35.26 ± 1.02 weeks. The readmission rates of patients in groups A, B, and C were 9.09%, 24.14%, and 58.06%; the preterm delivery rates were 9.09%, 3.45%, and 12.90%; and the length of stay was 4.02 ± 1.02 days, 12.53 ± 2.21 days, and 11.22 ± 2.09 days, respectively. The readmission rate was lower in group A than in groups B and C, the preterm delivery rate was lower in group B than in groups A and C, and the length of stay was shorter in group A than in groups B and C (all with statistically significant differences, P < 0.05).

Conclusion: Patients with acute cholecystitis in late pregnancy need to be appropriately graded for severity and offered a sound treatment strategy after a thorough assessment of the condition while taking into account the willingness of the patients. For patients with mild severity, conservative treatment can be adopted; for patients with moderate or severe inflammation, PTGD can be performed first for symptom control, and wait till after delivery for surgery to be considered; and in some cases of critical condition and poor symptom control, surgical intervention should be promptly performed.

Keywords: Acute cholecystitis; Conservative treatment; Laparoscopic cholecystectomy; Late pregnancy; Percutaneous transhepatic gallbladder drainage.

Publication types

Multicenter Study

MeSH terms

Adult
Cholecystectomy, Laparoscopic* / adverse effects
Cholecystitis, Acute* / surgery
Drainage / adverse effects
Female
Humans
Infant, Newborn
Pregnancy
Premature Birth* / etiology
Premature Birth* / surgery
Retrospective Studies
Treatment Outcome