Efficacy of percutaneous transhepatic gallbladder drainage for acute cholecystitis during pregnancy: a retrospective cohort study

Abstract

Contrary to the current guidelines, pregnant patients with moderate to severe acute cholecystitis (AC) often avoid surgery due to concerns of the potential maternal and fetal risks. Percutaneous transhepatic gallbladder drainage (PTGBD) can serve as an alternative to emergent cholecystectomy in the treatment of AC. It acts as a bridge to subsequent elective laparoscopic cholecystectomy and improves clinical outcomes for patients. However, no study has addressed the efficacy of PTGBD in pregnant patients. The aim of this study was therefore to determine the safety and efficacy of PTGBD in pregnant patients with moderate to severe AC. We retrospectively analyzed clinical data from pregnant patients with moderate to severe AC that were treated in our center between Jan 2006 and Dec 2020. The medical records were reviewed for patient demographics, laboratory test results, maternal and fetal outcomes, as well as the duration and cost of hospitalization. Follow-up evaluations were conducted via telephone or clinic visits. Sixty-six pregnant patients with moderate to severe AC were included in the present study, of whom 19 underwent PTGBD and 47 received conservative treatment. The PTGBD procedure showed a high success rate. We found that patients undergoing PTGBD had prolonged time from disease onset to initial intervention (4.89 ± 2.51 vs. 3.60 ± 1.73 days, p = 0.0187), better post-intervention WBC count improvement (7.88 ± 2.53 × 10^9/L vs. 11.14 ± 4.04 × 10^9/L, p = 0.002), lower AC recurrence rate during pregnancy (10.53% vs. 44.68%, p = 0.008), and fewer maternal/fetal complications (15.79% vs. 42.55%, p = 0.039), when compared to those received conservative treatment. Fifteen of 19 patients (78.95%) in the PTGBD group successfully underwent elective cholecystectomy after delivery. PTGBD is a safe and effective intervention for the management of moderate-to-severe AC in pregnant women. It can act as a valuable bridging measure to defer elective surgery and ultimately improves clinical maternal and fetal outcomes. This clinical research was registered at Chinese Clinical Trial Registry under registration number ChiCTR2200065396 on November 3, 2022. PTGBD appears to be a safe and effective alternative for managing moderate to severe acute cholecystitis during pregnancy, with reduced recurrence and improved maternal and fetal outcomes compared with conservative treatment. It may serve as a useful bridge to postpartum elective cholecystectomy, and offer a practical management strategy when surgery is deferred during pregnancy.