Operative versus nonoperative treatment of acute cholecystitis during pregnancy: a systematic review and meta-analysis.

BACKGROUND

Acute cholecystitis is the second most common non-obstetric abdominal emergency in pregnant women, with potential impact on both maternal and fetal outcomes. As the optimal treatment approach remains a subject of debate, we conducted this systematic review and meta-analysis to assess the safety of operative versus nonoperative treatment of acute cholecystitis during pregnancy.

METHODS

PubMed, Embase, and Cochrane Library databases were searched from inception to October 3, 2024. We conducted statistical analysis using Review Manager 5.4.1, employing a random-effects model to calculate the pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CIs) for dichotomous and continuous outcomes, respectively.

RESULTS

We included nine studies (45,883 pregnant women). Operative treatment significantly reduced the composite of adverse pregnancy outcomes (OR 0.60; 95% CI 0.42 to 0.87) and length of hospital stay (MD - 7.15; 95% CI - 7.83 to - 6.47) compared to nonoperative treatment. However, maternal mortality (OR 0.64; 95% CI 0.28 to 1.47), pregnancy loss (OR 1.21; 95% CI 0.66 to 2.22), preterm delivery (OR 0.64; 95% CI 0.32 to 1.30), and readmission rate (OR 0.15; 95% CI 0.02 to 1.03) were similar between the groups. In the sensitivity analysis, after the exclusion of the main source of heterogeneity, operative treatment was also associated with decreased preterm delivery and readmission rate.

CONCLUSION

Cholecystectomy is associated with a significant reduction in adverse pregnancy outcomes and length of hospital stay and should be the treatment of choice for pregnant patients with acute cholecystitis.