Ulus Travma Acil Cerrahi Derg. 2019; 25(2): 154-158 | DOI: 10.5505/tjtes.2018.82357

Management of Acute Cholecystitis During Pregnancy: A Single Center Experience

Bora Barut¹, Fatih Gönültaþ¹, Ali Fuat Kaan Gök², Tevfik Tolga Þahin^1
1Department of General Surgery, Ýnönü University Faculty of Medicine, Malatya-Turkey
²Department of General Surgery, Ýstanbul University Ýstanbul Faculty of Medicine, Ýstanbul-Turkey

BACKGROUND: This study aimed to present to evaluate the results of two different approaches in the management of acute cholecystitis
during pregnancy: immediate surgery and delayed surgery following conservative management.
METHODS: In this study, 20 pregnant women who were treated in our clinic for acute cholecystitis between 2010 and 2018 were included
in the analysis. Demographic characteristics, parameters related with acute cholecystitis (gallbladder wall thickness, laboratory
data), duration of hospitalization, readmission rates, and preterm labor rate were retrospectively evaluated.
RESULTS: The median age was 29.5 years. The median gestational week was 20 (6–32) weeks. Laparoscopic cholecystectomy was
performed in 6 (30%) patients on admittance. When compared with the conservative management group, patients who received immediate
surgery had higher gallbladder wall thickness. WBC count, and CRP, ALT, AST, ALP, and GGT levels (p<0.05). Furthermore,
readmission rate and duration of hospitalization were lower in the patients who underwent immediate surgery (p<0.05). The preterm
labor rate in conservative management and immediate surgery groups were 28.5% and 0%, respectively (p>0.05).
CONCLUSION: In this study, even though these patients had thicker gallbladder wall and higher inflammatory markers suggesting
severe inflammation, the outcome of early surgery was better than conservative management. Although the characteristics of the
conservative management group was more favorable, complication rate seemed to be high.

Keywords: Acute cholecystitis, choledocholithiasis, cholelithiasis; pregnancy.

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Gebe hastalarda akut kolesist tedavisi: Tek merkez deneyimi

Bora Barut¹, Fatih Gönültaþ¹, Ali Fuat Kaan Gök², Tevfik Tolga Þahin^1
1Ýnönü Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalý Malatya,Türkiye
²Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Genel Cerrahi Anabilim Dalý Ýstanbul,Türkiye

AMAÇ: Gebe hastalarda akut kolesistit tedavisi zordur. Bu çalýþmanýn amacý merkezimizde akut kolesistit nedeniyle ameliyat edilen gebe hastalarda laparoskopik kolesistektominin etkinliðinin araþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: 2010 ve 2018 yýllarý arasýnda merkezimizde akut kolesistit nedeniyle tedavi edilen 20 hasta deðerlendirmeye alýndý. Bu hastalardan sadece bir tanesi merkezimizde takiplerine gelmedi, kalan hastalar çalýþmaya alýndý. Hastalarýn demografik özellikleri, akut olesistit ile iliþkili radyolojik ve laboratuvar parametreleri, hastanede kalýþ, tekrar baþvuru oranlarý ve erken eylem oranlarý geriye dönük olarak analiz edildi.
BULGULAR: Ortanca yaþ 29.5 (21–46) yýldý. Ortanca gebelik haftasý 20 (6–32) hafta idi. Altý (%30) hastaya indeks yatýþta laparoskopik kolesistektomi gerçekleþtirildi. Erken kolesistektomi yapýlan hastalarda safra kesesi duvar kalýnlýðý, lökosit sayýsý, CRP, ALT, AST, ALP, GGT konzervatif izlenen hastalara göre daha fazla idi (p<0.05). Bunun yanýnda erken cerrahi uygulana grupta tekrar baþvuru ve hastanede yatýþ süresi daha az olarak gözlendi(p<0.05). Preterm eylem erken kolesistektomi ve konzervatif izlem grubunda sýrasýyla %0 ve %28.5 olarak bulundu (p>0.05).
TARTIÞMA: Erken cerrahi uygulanan hastalarýn karaciðer fonksiyon ve kolestatik testleri daha fazla olmasýna ve enflamatuvar belirteçleri daha yüksek olmasýna raðmen kolesistektomi güvenle gerçekleþtirilmiþtir. Konzervatif izlem grubunda daha uzun hastanede yatýþ ve daha fazla preterm eylem oraný gözlenmiþtir. Dolayýsý ile gebelerde akut kolesistitte tedavide cerrahi güvenli ve etkindir.

Anahtar Kelimeler: Akut kolesistit, gebelik; koledokolitiazis; kolelitiazis.

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