Is cholecystectomy necessary before planning pregnancy?

Question

Hello doctor,

I am a 34-year-old female ophthalmologist. I have a single gallstone which is 10 mm in size that was noticed incidentally in ultrasound. Is it necessary to undergo cholecystectomy before planning my second pregnancy? I had nonspecific episodes of abdominal pain in the last two years which were not typical of gallbladder pain because the pain was more located in the center and lower abdomen. But the intensity of the pain was severe and was associated with nausea, and vomiting which relieved only after taking intramuscular painkillers.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your case and reports (attachment removed to protect patient identity). This looks like a symptomatic uncomplicated gallbladder stones. Even though you say that the symptoms have not been typical of biliary colic but the repeated episodes of pain, need for parenteral analgesics, and no other attributable cause leads to consider gallbladder stones as the cause for your pain.

Without surgery, there is 50 % chance of recurrent pain episodes per year, 2 % chance of biliary complications per year, and 30 % will have no further pain if there was only one episode of biliary pain previously. The best option in this situation is laparoscopic cholecystectomy especially if you are planning a pregnancy. Since during pregnancy, the risk of recurrent pain and complications are higher.

The other issue is that risk of surgery in the first and third trimester is significantly higher with the preferable period for surgery in pregnancy being the second trimester. You can consider medical dissolution therapy of gallstones but the efficacy is 30 to 49 %. And this is mainly based on the unimpaired motor activity of gallbladder, which has to be assessed before therapy (only with good motor activity of gallbladder the efficacy of 30 to 49 % can be predicted). The best option in your case is laparoscopic cholecystectomy.