Gallbladder and appendix surgery safe in pregnancy

Pregnant women are at no greater risk of developing an infection or other complication after having their gallbladder or appendix removed than their non-pregnant counterparts, researchers report in a new study.

“Often surgery is necessary in pregnancy and, in fact, it probably promotes not only the health of the woman, but her pregnancy as well,” said Dr. Jeffrey Ecker, an obstetrician at Massachusetts General Hospital, who was not involved in this study.

There had been some concern that pregnancy could pose an additional risk during surgery, said Dr. Elisabeth Erekson, a professor at Yale School of Medicine and the lead author of the study.

But many of the reports of the past didn’t compare the outcomes in pregnant women to similar women who were not pregnant.

Erekson and her colleagues collected data on nearly 1,300 moms-to-be and more than 51,000 similarly aged women who weren’t pregnant. Their information came from a database designed to track how well people fare after surgery.

Among more than 800 pregnant women who had their appendix removed, about four out of every 100 landed up with a complication within a month of the surgery.

This included an infection, an embolism, death, heart attack, or a return to the operating room.

Of the 19,000 non-pregnant women who also had an appendectomy, three out of every 100 had a complication.

The difference was most likely due to chance, the researchers concluded.

About two out of every 100 women who had their gallbladder removed experienced a problem after the surgery, but the rate was the same regardless of whether or not they were pregnant.

Erekson told Reuters Health that the results are reassuring for pregnant women in need of surgery.

“The good news is there is not an increased risk to her. If she has appendicitis, it is a good idea to proceed with the surgery” if her doctor advises it, Erekson said.


Ecker said that the study backs up what obstetricians would usually recommend for their patients: necessary, emergent surgeries, such as for appendicitis or a broken leg, should not be delayed because of pregnancy.

He added that it’s still wise to push off elective procedures until after the pregnancy is over.

In some cases, such as for gallbladder removal to treat inflammation, it’s a tough call. Ecker told Reuters Health that the inflammation might not necessarily be an emergency, but it could be a good idea to remove the gallbladder before it gets worse.

“For those in-between cases it requires a careful conversation,” said Ecker, who is also vice chair of the American College of Obstetrics and Gynecology’s committee on Obstetric Practice. “But one of the things that don’t need to be focused on in that conversation is, ‘Is it worse from the perspective of my health because I’m pregnant?’”

The study, published in the medical journal Obstetrics and Gynecology, did not determine whether surgery posed additional risks to the health of the fetus.

Erekson said that earlier reports “tend to support that the fetus does well under anesthesia.”

Ecker said he’d like to see larger studies that track the outcomes of babies whose mothers had surgery while pregnant.

SOURCE: Obstetrics and Gynecology, December, 2011.

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