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Arkenbosch JHC, van Ruler O, de Vries AC. Non-obstetric surgery in pregnancy (including bowel surgery and gallbladder surgery). Best Pract Res Clin Gastroenterol 2020; 44-45:101669. [PMID: 32359684 DOI: 10.1016/j.bpg.2020.101669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/21/2020] [Accepted: 03/05/2020] [Indexed: 01/31/2023]
Abstract
Non-obstetric surgery during pregnancy is required in 0.75-2% of pregnancies. Physiologic changes during pregnancy, both hormonal and anatomic, can have interactions with surgery and anesthesia. Indication, timing as well as risks of anesthesia and surgery should be considered in surgical decision making. The health status of the mother should always be put first. A preoperative multidisciplinary approach, also including an obstetrician and neonatologist, is mandatory. Delay in diagnosis and treatment carry risks of complications in all septic visceral indications. Considerations should be individualized.
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Affiliation(s)
- J H C Arkenbosch
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - O van Ruler
- Department of Surgery, IJsselland Hospital, Prins Constantijnweg 2, Room M1-109, 2906 ZC, Capelle aan den IJssel, the Netherlands.
| | - A C de Vries
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
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2
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Bowie JM, Calvo RY, Bansal V, Wessels LE, Butler WJ, Sise CB, Shaw JG, Sise MJ. Association of complicated gallstone disease in pregnancy and adverse birth outcomes. Am J Surg 2020; 220:745-750. [PMID: 32067705 DOI: 10.1016/j.amjsurg.2020.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Complicated gallstone disease (CGD) is a common condition requiring intervention during pregnancy to avert adverse birth outcomes (ABO). METHODS Cohort study using the California OSHPD 2007-2014 database. Records of pregnant patients were analyzed for gallbladder calculus within four months of delivery. Biliary system interventions were evaluated as the primary exposure. RESULTS Of 7,597 patients, those with CGD had a greater likelihood of biliary system procedures than those with uncomplicated gallstone disease (36.6% vs. 2.5%, p < 0.001). Patients with CGD also had increased odds of ABO (OR 2.02, 95% CI, 1.48-2.76). Compared to patients without biliary system procedures, those with interventions for gallstones had an OR of 3.46 (95% CI, 2.48-4.82) for ABO. After adjustment, biliary system intervention for CGD had an even greater risk of ABO (OR 4.26, 95% CI, 2.86-6.35). CONCLUSIONS The risk of ABO is significantly increased in women with CGD and intervention for gallstones.
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Affiliation(s)
- Jason M Bowie
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA
| | - Richard Y Calvo
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA
| | - Vishal Bansal
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA
| | - Lyndsey E Wessels
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA
| | - William J Butler
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA
| | - C Beth Sise
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA
| | - Jennifer G Shaw
- Department of Obstetrics and Gynecology, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA
| | - Michael J Sise
- Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA.
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3
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Pearl JP, Price RR, Tonkin AE, Richardson WS, Stefanidis D. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 2017. [DOI: 10.1007/s00464-017-5637-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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4
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EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 2016; 65:146-181. [PMID: 27085810 DOI: 10.1016/j.jhep.2016.03.005] [Citation(s) in RCA: 267] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023]
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5
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Sedaghat N, Cao AM, Eslick GD, Cox MR. Laparoscopic versus open cholecystectomy in pregnancy: a systematic review and meta-analysis. Surg Endosc 2016; 31:673-679. [DOI: 10.1007/s00464-016-5019-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/03/2016] [Indexed: 01/09/2023]
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6
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Barber-Millet S, Bueno Lledó J, Granero Castro P, Gómez Gavara I, Ballester Pla N, García Domínguez R. Update on the management of non-obstetric acute abdomen in pregnant patients. Cir Esp 2016; 94:257-65. [PMID: 26875476 DOI: 10.1016/j.ciresp.2015.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 12/29/2022]
Abstract
Acute abdomen is a rare entity in the pregnant patient, with an incidence of one in 500-635 patients. Its appearance requires a quick response and an early diagnosis to treat the underlying disease and prevent maternal and fetal morbidity. Imaging tests are essential, due to clinical and laboratory masking in this subgroup. Appendicitis and complicated biliary pathology are the most frequent causes of non-obstetric acute abdomen in the pregnant patient. The decision to operate, the timing, and the surgical approach are essential for a correct management of this pathology. The aim of this paper is to perform a review and update on the diagnosis and treatment of non-obstetric acute abdomen in pregnancy.
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Affiliation(s)
| | - José Bueno Lledó
- Servicio de Cirugía, Hospital Universitari i Politècnic La Fe, Valencia, España
| | | | | | - Neus Ballester Pla
- Servicio de Cirugía, Hospital Universitari i Politècnic La Fe, Valencia, España
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7
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Jorge AM, Keswani RN, Veerappan A, Soper NJ, Gawron AJ. Non-operative management of symptomatic cholelithiasis in pregnancy is associated with frequent hospitalizations. J Gastrointest Surg 2015; 19:598-603. [PMID: 25650166 DOI: 10.1007/s11605-015-2757-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 01/21/2015] [Indexed: 01/31/2023]
Abstract
Symptomatic cholelithiasis (SC) is common in pregnancy. Guidelines recommend laparoscopic cholecystectomy (LC) for SC in pregnancy. Our aim was to evaluate current practice patterns and outcomes for patients undergoing initial non-operative management for uncomplicated SC during pregnancy. We performed a retrospective analysis and telephone survey of all patients presenting in a 42-month period to a tertiary care center for uncomplicated SC during pregnancy. Women with complicated gallstone disease, including cholecystitis, pancreatitis, choledocholithiasis, and cholangitis were excluded. We identified 53 patients with uncomplicated SC during pregnancy. LC was performed in 4 (7.5%) antepartum and in 28 (51.7%) postpartum. The majority of LCs (21, 75%) were performed within 3 months postpartum. Of those with postpartum LC, 22 (78.6%) had recurrent postpartum symptoms prior to LC, and 14 (50%) had repeat hospitalizations prior to undergoing surgery. Given the safety of antepartum LC and the frequency of recurrent symptoms and hospitalizations, early surgical intervention during pregnancy may be the optimal strategy to reduce antepartum and early postpartum admissions for uncomplicated SC.
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Affiliation(s)
- April M Jorge
- Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Chicago, USA
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8
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Diegelmann L. Nonobstetric abdominal pain and surgical emergencies in pregnancy. Emerg Med Clin North Am 2012; 30:885-901. [PMID: 23137401 DOI: 10.1016/j.emc.2012.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The focus of this article is the evaluation and management of pregnant patients with nonobstetric abdominal pain and surgical emergencies. The anatomic and physiologic changes that occur during pregnancy can cause difficulties in interpreting patients' signs and symptoms in emergency departments. This article reviews some of the common causes of nonobstetric abdominal pain and surgical emergencies that present to emergency departments and discusses some of the literature surrounding the use of imaging modalities during pregnancy. After a review of these changes and their causes, imaging modalities that can be used for the assessment are discussed.
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Affiliation(s)
- Laura Diegelmann
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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9
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Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 2011; 25:3479-92. [PMID: 21938570 DOI: 10.1007/s00464-011-1927-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/24/2011] [Indexed: 12/11/2022]
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Date R, Kaushal M, Ramesh A. A review of the management of gallstone disease and its complications in pregnancy. Am J Surg 2008; 196:599-608. [DOI: 10.1016/j.amjsurg.2008.01.015] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 01/19/2008] [Accepted: 01/14/2008] [Indexed: 10/21/2022]
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11
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Cappell MS. Hepatic disorders mildly to moderately affected by pregnancy: medical and obstetric management. Med Clin North Am 2008; 92:717-37, vii. [PMID: 18570940 DOI: 10.1016/j.mcna.2008.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hepatic, biliary, and pancreatic disorders are often complex and clinically challenging during pregnancy. Hepatic disorders can affect the pregnancy and vice versa. The differential diagnosis of hepatic diseases is particularly broad during pregnancy because it includes disorders related to, and unrelated to, pregnancy. This article discusses the physiologic effects of pregnancy on liver function; the differential diagnosis of hepatic findings during pregnancy; modifications of abdominal imaging and hepatobiliary endoscopic procedures during pregnancy; and the medical and obstetric management of hepatic, biliary, and pancreatic diseases that are mildly to moderately affected by pregnancy.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, William Beaumont Hospital, MOB 233, 3535 West Thirteen Mile Road, Royal Oak, MI 48073, USA.
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12
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Jackson H, Granger S, Price R, Rollins M, Earle D, Richardson W, Fanelli R. Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review. Surg Endosc 2008; 22:1917-27. [PMID: 18553201 DOI: 10.1007/s00464-008-9989-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Accepted: 05/05/2008] [Indexed: 12/16/2022]
Abstract
Treatment of surgical disease in the gravid patient requires a unique and careful approach where safety of the mother and fetus are both considered. Approaches to diagnosis and therapy of surgical disease in the gravid patient are increasingly clarified and defined in the literature. Laparoscopy, once described as contraindicated in pregnancy, has been steadily accepted and applied as data supporting its safety and use have accumulated. An extensive review of the literature was performed to define the use of laparoscopy in pregnancy. Diagnoses for independent surgical diseases as well as imaging modalities and techniques during pregnancy are reviewed. Preoperative, intraoperative, and postoperative management of the pregnant patient are described and evaluated with focus on use of laparoscopy. Literature supporting safety and efficacy of laparoscopy in cholecystectomy, appendectomy, solid organ resection, and oophorectomy in the gravid patient is outlined. Based on level of evidence, this review includes recommendations specific to surgical approach, trimester of pregnancy, patient positioning, port placement, insufflation pressure, monitoring, venous thromboembolic prophylaxis, obstetric consultation, and use of tocolytics in the pregnant patient.
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Affiliation(s)
- Heidi Jackson
- Department of Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
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13
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Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 2008; 22:849-61. [DOI: 10.1007/s00464-008-9758-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Accepted: 01/08/2008] [Indexed: 01/06/2023]
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Syed A, Widdisson A, Verity LJ. Laparoscopic cholecystectomy at 32 weeks of pregnancy. J OBSTET GYNAECOL 2007; 27:426-7. [PMID: 17654203 DOI: 10.1080/01443610701325812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A Syed
- Department of Obstetrics and Gynaecology, Royal Cornwall Hospital, Truro, UK.
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15
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Jabbour N, Brenner M, Gagandeep S, Lin A, Genyk Y, Selby R, Mateo R. Major Hepatobiliary Surgery during Pregnancy: Safety and Timing. Am Surg 2005. [DOI: 10.1177/000313480507100416] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hepatobiliary disease, although rare, may present during pregnancy with potential complications for mother and fetus. We present two cases of choledochal cysts and one case of a hepatic adenoma diagnosed in gravid patients. All three patients had acute events or failed medical management and were successfully treated with open resection, excision, or reconstruction during the second or third trimesters of pregnancy without requiring blood transfusions or tocolytic therapy. Although conservative treatment may be indicated in select patients due to the risk of underlying disease, we recommend surgical treatment preferably in the second trimester. With diligent intra- and postoperative management, pregnant patients can safely proceed with major hepatobiliary surgery.
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Affiliation(s)
- Nicolas Jabbour
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
| | - Megan Brenner
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
| | - Singh Gagandeep
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
| | - Abe Lin
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
| | - Yuri Genyk
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
| | - Rick Selby
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
| | - Rodrigo Mateo
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
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Angelini DJ. Obstetric triage revisited: update on non-obstetric surgical conditions in pregnancy. J Midwifery Womens Health 2003; 48:111-8. [PMID: 12686943 DOI: 10.1016/s1526-9523(02)00417-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
New findings and diagnostic advances warrant revisiting key features of acute non-obstetric abdominal pain in pregnancy. Four of the most frequently seen conditions warranting surgical intervention are: appendicitis, cholecystitis, pancreatitis, and bowel obstruction. Because pregnancy often masks abdominal complaints, effectively assessing and triaging abdominal pain in pregnant women can be difficult. Working in obstetric triage settings and triaging obstetric phone calls demand continual updating of abdominal assessment knowledge and clinical skills.
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Affiliation(s)
- Diane J Angelini
- Department of Obstetrics-Gynecology, Brown University, Providence, Rhode Island, USA
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Abstract
Numerous medical, surgical, psychiatric, gynecologic, and obstetric disorders can cause abdominal pain during pregnancy. The patient history, physical examination, laboratory data, and radiologic findings usually provide the diagnosis. The pregnant woman has physiologic alterations that affect the clinical presentation, including atypical normative laboratory values. Abdominal ultrasound is generally the recommended radiologic imaging modality; roentgenograms are generally contraindicated during pregnancy because of radiation teratogenicity. Concerns about the fetus limit the pharmacotherapy. Maternal and fetal survival have recently increased in many life-threatening conditions, such as ectopic pregnancy, appendicitis, and eclampsia, because of improved diagnostic technology, better maternal and fetal monitoring, improved laparoscopic technology, and earlier therapy.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, 760 Broadway Avenue, Brooklyn, NY 11206, USA
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Abstract
Although little data exist directly evaluating the utility and safety of endoscopy in the pregnant woman with IBD, it appears to be well tolerated by both mother and fetus, and provides useful clinical information. When performed to evaluate gastrointestinal bleeding, EGD has a high diagnostic yield, while EGD for nausea and vomiting is less informative. In the patient without IBD presenting with hematochezia, unexplained diarrhea, severe abdominal pain, or severe rectal pain, careful sigmoidoscopic examination is indicated, often leading to a diagnosis of new-onset or unsuspected IBD. Likewise, the pregnant IBD patient with worsening symptoms, despite appropriate medical therapy, may also benefit from sigmoidoscopy. Colonoscopy is less often indicated, but can be safely performed in the carefully selected pregnant patient. In all cases obstetrical consultation should be obtained prior to endoscopy, and the risks and benefits of endoscopy to both mother and child should be considered. Close attention should be paid to appropriate drug selection for conscious sedation, and sedation should be administered to provide patient comfort, while avoiding oversedation. Extrapolating from data obtained during endoscopic examination of the pregnant non-IBD patient, fetal monitoring is generally not indicated, although it should be considered for the high-risk or late third-trimester patient. Following these principles assures that endoscopy can be safely performed in the pregnant IBD patient with the best possible outcome for both mother and baby.
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Affiliation(s)
- Jeffry A Katz
- Division of Gastroenterology, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106-5066, USA.
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Abstract
Gallbladder disease and pancreatitis are two nonobstetric abdominal-related complaints presenting during pregnancy; gallbladder-related surgery in pregnancy is second only to appendectomy. Pancreatitis is seen less often but its most common cause is gallstone-related pain. The purpose of this manuscript is to review the clinical assessment and management of these disorders in pregnancy and to make nurses aware of the most current clinical options and techniques.
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Affiliation(s)
- Diane J Angelini
- Department of Obstetrics and Gynecology, Brown University, Women and Infants' Hospital Providence, Rhode Island, USA
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Abstract
PURPOSE Since the start of laparoscopic cholecystectomy, a debate about its use in the gravid patient has remained controversial. Concerns about the morbidity and mortality in the mother and fetus through all trimesters have been expressed. The objective of this retrospective review was to further evaluate the safety of laparoscopic cholecystectomy in the pregnant patient. METHODS At Covenant Health Care-Cooper Campus and Harrison Campus in Saginaw, Michigan, 10 cholecystectomies in pregnant patients were performed from 1995 to April 1998. Eight of these patients were done with laparoscopy, and 2 were done through the open technique. RESULTS No mortality or significant morbidity occurred in the laparoscopic group. However, the open group did have a fetal mortality. CONCLUSIONS Our study showed that laparoscopic cholecystectomy can be performed safely in the pregnant patient in the first 2 trimesters. This is consistent with the findings in the current world literature.
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Affiliation(s)
- Sujal G Patel
- Deparment of Surgery, Saginaw Cooperative Hospitals, Inc., Saginaw, Michigan, USA
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Edwards RK, Ripley DL, Davis JD, Bennett BB, Simms-Cendan JS, Cendan JC, Stone IK. Surgery in the pregnant patient. Curr Probl Surg 2001; 38:213-90. [PMID: 11296493 DOI: 10.1067/msg.2001.112768] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- R K Edwards
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, USA
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Curet MJ. Special problems in laparoscopic surgery. Previous abdominal surgery, obesity, and pregnancy. Surg Clin North Am 2000; 80:1093-110. [PMID: 10987026 DOI: 10.1016/s0039-6109(05)70215-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Previous surgery, obesity, and pregnancy should no longer be considered contraindications to laparoscopic surgery. Surgeons should exercise good judgement in patient selection, use meticulous surgical techniques, and prepare thoroughly for the planned procedure. Patients and surgeons should be aware of increased conversion rates. With these caveats in mind, these patients can still experience the advantages of minimally invasive surgery without increased risks.
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Affiliation(s)
- M J Curet
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, USA
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Cosenza CA, Saffari B, Jabbour N, Stain SC, Garry D, Parekh D, Selby RR. Surgical management of biliary gallstone disease during pregnancy. Am J Surg 1999; 178:545-8. [PMID: 10670869 DOI: 10.1016/s0002-9610(99)00217-2] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Biliopancreatic gallstone disorders (BPD) manifesting during pregnancy are relatively rare. The management of these conditions remains controversial. Although perioperative problems and fetal loss have been reported, recent publications have advocated an early surgical approach. PATIENTS AND METHODS Thirty-two pregnant women underwent operation for BPD between January 1993 and December 1997. The mean age was 29 years and ranged from 18 to 41 years. RESULTS Twelve patients underwent a laparoscopic cholecystectomy (LC), and 20 open cholecystectomies (OC), including two conversions from laparoscopic. Seven of the OC patients required additional open CBD exploration and intraoperative choledochoscopy for CBD stones. No maternal mortality was observed. A single fetal demise (3%) occurred for a patient with gallstone pancreatitis who underwent open cholecystectomy during her 14th week of gestation. CONCLUSIONS Early involvement of the obstetric team, with preoperative and postoperative fetal monitoring, and adequate management of anesthetic and tocolytic agents make cholecystectomy a safe procedure at any stage of pregnancy.
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Affiliation(s)
- C A Cosenza
- Department of Surgery, LAC/USC Medical Center, Los Angeles, California 90003, USA
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