Особенности диагностики и хирургической тактики при осложненном течении желчекаменной болезни у беременных и рожениц в многопрофильном стационаре III Б уровня: ОРИГИНАЛЬНЫЕ СТАТЬИ

Дмитрий Николаевич  Попов; Андрей Юрьевич  Корольков; Виталий Фёдорович  Беженарь; Александр Александрович  Смирнов; Марина Магомедовна  Саадулаева; Дана Докковна  Паскошева; Сергей Федорович  Багненко

doi:10.56871/PED.2026.43.88.004

Features of diagnostics and surgical tactics in complicated course of gallstone disease in pregnant women and women in labor at a III B level hospital

ORIGINAL STUDIES

Dmitry N. Popov Pavlov First Saint Petersburg State Medical University https://orcid.org/0000-0001-6995-4601
Andrey Yu. Korolkov Pavlov First Saint Petersburg State Medical University https://orcid.org/0000-0001-7449-6908
Vitaly F. Bezhenar Pavlov First Saint Petersburg State Medical University https://orcid.org/0000-0002-7807-4929
Alexandr A. Smirnov Pavlov First Saint Petersburg State Medical University https://orcid.org/0000-0002-6440-2370
Marina M. Saadulaeva Pavlov First Saint Petersburg State Medical University https://orcid.org/0000-0001-7779-7730
Dana D. Paskosheva Pavlov First Saint Petersburg State Medical University
Sergey F. Bagnenko Pavlov First Saint Petersburg State Medical University https://orcid.org/0000-0002-6380-137X

Keywords:

pregnancy extragenital pathology acute cholecystitis choledocholithiasis biliary pancreatitis беременность экстрагенитальная патология острый холецистит холедохолитиаз билиарный панкреатит

Abstract

Introduction.Cholecystectomy is the second most common non-obstetric operation during gestation. The complicated course of gallstone disease in pregnant women requires a timely multidisciplinary approach. However, the optimal timing and methods of surgical intervention remain subjects of debate.

Objective.The aim of the study was analyzing the results of using various instrumental diagnostic methods and evaluating the effectiveness and safety of hybrid operations in pregnant women and parturients with complicated course of gallstone disease in a multidisciplinary level IIIB hospital for optimizing diagnostic and treatment tactics.

Materials and methods.A retrospective analysis was performed on 183 cases of hospitalization of pregnant women with symptomatic gallstone disease.Patients underwent examination using ultrasound, magnetic resonance cholangiopancreatography, and endoscopic ultrasonography. The results of a scoring system for predicting the risk of complications and the effectiveness of hybrid surgeries were evaluated.

Results.In 104 patients with biliary colic, the use of a scoring system for predicting the risk of complications reduced the incidence of complications from 35.0 to 12.5% (p=0.001), shortened hospital stay (from 10.5 to 5.1 days), and reduced the rate of emergency surgeries (from 18.8 to 7.7%). In patients with acute cholecystitis, cholecystectomy was performed laparoscopically in 73.5% of cases, predominantly at 32/33 weeks of gestation. In patients with suspected choledocholithiasis, endoscopic ultrasonography allowed detection of small calculi (<3 mm) in 73.3% of cases despite negative magnetic resonance cholangiopancreatography findings. In 37 patients with confirmed choledocholithiasis, simultaneous hybrid procedures (laparoscopic cholecystectomy + endoscopic papillosphincterotomy) were successfully performed, with the rendezvous technique used in 48.6% of cases. The rate of preterm birth was 5.4%, and no intraoperative complications occurred.

Conclusions.Using a scoring system to assess the risk of cholelithiasis complications in pregnant women can reduce their incidence. endoscopic ultrasonography is more effective in diagnosing choledocholithiasis in pregnant women than magnetic resonance cholangiopancreatography. Hybrid procedures are not associated with an increased complication rate and do not negatively impact the course of pregnancy.

Author Biographies

Dmitry N. Popov, Pavlov First Saint Petersburg State Medical University

MD, Ph D, Assistant, Hospital Surgery Department No. 2 with Clinic named after Academician F.G. Uglov, Head of the Surgical Department No. 4 (emergency surgery) of the Research Institute of Surgery and Emergency Medicine, Pavlov First Saint Petersburg State Medical University; address: 6–8 L’va Tolstogo str., Saint Petersburg, 197022, Russia

Andrey Yu. Korolkov, Pavlov First Saint Petersburg State Medical University

MD, Ph D, Dr Med Sci, Professor, Head of the Hospital Surgery Department No. 2 with Clinic named after Academician F.G. Uglov, Head of the Department of General and Emergency Surgery of the Research Institute of Surgery and Emergency Medicine, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia

Vitaly F. Bezhenar, Pavlov First Saint Petersburg State Medical University

MD, Ph D, Dr Med Sci, Professor, Head
of the Department of Obstetrics, Gynecology and Neonatology, Head of the Clinic of Obstetrics and Gynecology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia

Alexandr A. Smirnov, Pavlov First Saint Petersburg State Medical University

MD, Ph D, Dr Med Sci, Head of the Endoscopy Department of the Research Institute of Surgery and Emergency Medicine, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia

Marina M. Saadulaeva, Pavlov First Saint Petersburg State Medical University

Endoscopist, Endoscopy Department No. 1 of the Research Institute of Surgery and Emergency Medicine, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia

Dana D. Paskosheva, Pavlov First Saint Petersburg State Medical University

Surgeon of Surgical Department No. 4 (emergency surgery) of the Research Institute of Surgery and Emergency Medicine, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia

Sergey F. Bagnenko, Pavlov First Saint Petersburg State Medical University

MD, Ph D, Dr Med Sci, Professor, Academician of the Russian Academy of Sciences, Rector, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia

References

1. Potter M. Observations of the gallbladder and bile during pregnancy at term. JAMA. 1936;106(13):1070–1074. https://doi.org/10.1001/jama.1936.02770130020006.

2. Glenn F., Mc Sherry C.K. Pregnancy, cholesterol metabolism and gallstones. Ann Surg. 1969;169(5):712–723. https://doi.org/10.1097/00000658-196905000-00008.

3. Lynn J., Williams L., O’Brien J., Wittenberg J., Egdahl R.H. Effects of estrogen upon bile: implications with respect to gallstone formation. Ann Surg. 1973;178(4):514–524. https://doi.org/10.1097/00000658-197310000-00014.

4. Salari N., Hasheminezhad R., Heidarisharaf P., Khaleghi A., Azizi A., Shohaimi S., Mohammadi M. The global prevalence of gallstones in pregnancy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol X. 2023;19:100237. https://doi.org/10.1016/j.eurox.2023.100237.

5. Andersson B., Hedström J., Wide-Swensson D., Nilsson J. The impact of gallstone intervention during pregnancy on maternal and perinatal outcomes: a nationwide population-based cohort study. Scand J Gastroenterol, 2025;60(10):992–998. https://doi.org/10.1080/00365521.2025.2526773.

6. Hughes D., Hughes A., White P., Silva M. Acute pancreatitis in pregnancy: meta-analysis of maternal and fetal outcomes. Br J Surg. 2021;109(1):12–14. https://doi.org/10.1093/bjs/znab221.

7. Kumar S., Collings A., Wunker C., Athanasiadis D., De Long C., Hong J. et al. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc. 2024;38(6):2947–2963. https://doi.org/10.1007/s00464-024-10810-1.

8. Jelin E., Smink D., Vernon A., Brooks D. Management of biliary tract disease during pregnancy: a decision analysis. Surg Endosc. 2008;22(1):54–60. https://doi.org/10.1007/s00464-007-9220-1.

9. April M., Rajesh N., Anna V., Nathaniel J., Andrew J. Non-operative management of symptomatic cholelithiasis in pregnancy is associated with frequent hospitalizations. J Gastrointest Surg, 2015;19(4):598–603. https://doi.org/10.1007/s11605-015-2757-8.

10. Корольков А.Ю. Китаева М.А., Попов Д.Н. Тактика лечения желчекаменной болезни у беременных. В кн.: VII съезд хирургов Юга России с международным участием, 21–22 октября 2021 г. Тезисы. Пятигорск; 2021. С. 111–112.

11. Jorge A.M., Keswani R.N., Veerappan A., Soper N.J., Gawron A.J. Non-operative management of symptomatic cholelithiasis in pregnancy is associated with frequent hospitalizations. J Gastrointest Surg. 2015;19(4):598–603. https://doi.org/10.1007/s11605-015-2757-8.

12. Hassanesfahani M., Villavarajan B., Otusile I. et al. Between guidelines and reality; the complex decision-making of acute cholecystitis in pregnancy. Langenbecks Arch Surg. 2025;410(1):211. https://doi.org/10.1007/s00423-025-03768-8.

13. Lee J.J., Lee S.K., Kim S.H., Kim G.H., Park D.H., Lee S. et al. Efficacy and safety of pancreatobiliary endoscopic procedures during pregnancy. Gut Liver. 2015;9(5):672–678. https://doi.org/10.5009/gnl14217.

14. Haataja A., Kokki H., Uimari O., Kokki M. Non-obstetric surgery during pregnancy and the effects on maternal and fetal outcomes: A systematic review. Scand J Surg. 2023;112(3):187–205. https://doi.org/10.1177/14574969231175569.

15. ACOG Committee Opinion No. 775: Nonobstetric Surgery During Pregnancy. Obstet Gynecol. 2019;133(4):e285–e286. https://doi.org/10.1097/AOG.0000000000003174.