Cholecystectomy versus conservative management in pregnant women with uncomplicated acute cholecystitis: impact on maternal–fetal safety

Abstract

Introduction: Cholelithiasis and its complications represent the second most common cause of non-obstetric acute abdomen during pregnancy, carrying an elevated risk of maternal-fetal complications. Historically, conservative management has been preferred; however, recent studies support the safety and effectiveness of laparoscopic cholecystectomy during any trimester of pregnancy.

Objective: To evaluate the safety, feasibility, clinical, obstetric, and neonatal outcomes of laparoscopic cholecystectomy compared to conservative management in pregnant women with uncomplicated acute cholecystitis.

Methods: A systematic review was conducted according to PRISMA recommendations. Observational, retrospective, and prospective studies comparing laparoscopic cholecystectomy with conservative management during pregnancy were included, evaluating maternal and neonatal complications.

Results: Twenty-four studies involving 27 243 patients were analyzed. Laparoscopic cholecystectomy was predominantly performed during the second trimester and associated with fewer maternal complications (infection, hemorrhage, bile duct injury), decreased symptomatic recurrence, and fewer hospital readmissions compared to conservative management. Conservative treatment increased the incidence of preterm labor, fetal hypoxia, and fetal mortality. However, performing laparoscopic cholecystectomy during the third trimester was associated with a higher risk of preterm delivery.

Conclusions: Laparoscopic cholecystectomy is a safe and effective option during pregnancy, preferably during the second trimester. Its indication in the third trimester requires careful consideration due to increased risk of preterm delivery. Conservative management is associated with high symptomatic recurrence and neonatal complications; therefore, surgical intervention should not be unnecessarily delayed.