Abstract

PINILLA LIZARRAGA, Ramiro; ROMERO, Eduardo; ROJAS, Liliana  and  CLAROS, Nataniel. MANAGEMENT OF THE SINTOMATIC LITHIASIC GALLBLADER DISEASE DURING PREGNANCY. Rev. Méd. La Paz [online]. 2014, vol.20, n.2, pp.23-29. ISSN 1726-8958.

OBJETIVE: To determine the type of management of symptomatic lithiasic gallbladder disease (LGD) at Hospital Obrero No. 1. MATERIAL AND METHODS: Study design: Case series RESULTS: Prevalence of LGD in pregnant woman was 4,2 % (18 patients) of which 12 (66,7%) underwent surgery and 6 (33,3%) received medical treatment. Average age was 28.83 years, (SD± 5,328). Preoperative diagnostics included acute lithiasic gallbladder disease in 12 cases (66,6%), gallstone -induced acute pancreatitis in 3 cases (16,7%) and obstructive-jaundice syndrome due to choledocholithiasis in 3 cases (16,7%). Mean gestational age was 16.83 weeks (SD± 8,155). 5 cases (27,7%) presented symptoms during the first trimester, 10 (55,6%) during the second trimester and 3 cases (16,7%) presented symptoms during the third trimester. Only 3 cases (16,6%) were primiparous. Mean white blood cell count was 10632 x mm³ (SD± 2748,038), 66% presented leukocytosis with left shift. Laparoscopic cholecystectomy (LC) was performed in 10 cases out of 12 and in 2 cases exploration of biliary ducts was performed. Balanced general anesthesia was administered in 10 cases (83,4%), total intravenous anesthesia (TIVA) in 8,3% and spinal anesthesia in 8,3%. Pneumoperitoneum was performed in all cases with the Hasson's open access technique. Mean surgical time was 47,5 minutes, (SD±16,989) and average hospital stay was 5,44 days (SD±3,568). Pregnant women who underwent surgery had a longer stay compared to the ones who received medical treatment (6,16 vs 4 days). No fetal complications were observed including mortality of the maternal fetal dyad nor premature contractions that required any treatment. CONCLUSIONS: LC seems to be a safe option of treatment when GBD is persistently symptomatic in the second trimester of pregnancy.

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