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OPERATIVE VERSUS NONOPERATIVE TREATMENT OF ACUTE CHOLECYSTITIS DURING PREGNANCY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Marcelo A. Martins
2, Gilmara C. Meine
*1, Júlia Gonçalves Gadelha
3, Augusto Graziani e Sousa
4, Barbara Bombassaro Masiero
5, Sergio M. de Figueiredo
61Department of Internal Medicine (Division of Gastroenterology), Universidade FEEVALE, Novo Hamburgo, RS, Brazil; 2Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil; 3Afaya Faculdade de Ciências Médicas da Paraíba, João Pessoa, PB, Brazil; 4Centro Universitário de Anápolis, Anápolis, GO, Brazil; 5Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, RS, Brazil; 6The University of North Carolina at Chapel Hill, Chapel Hill, NC
BACKGROUND AND AIMS: Acute cholecystitis is the second most common non-obstetric abdominal emergency in pregnant women, with a 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 systematically searched from inception to October 3, 2024. Inclusion criteria were (a) comparative studies, (b) assessing the efficacy of operative
versus nonoperative treatment, (c) in pregnant women with acute cholecystitis, and (d) reporting at least one outcome of interest. The primary outcomes were maternal mortality and adverse pregnancy outcomes (a composite outcome that includes pregnancy loss and preterm delivery). Secondary outcomes were pregnancy loss, preterm delivery, the length of hospitalization, and readmission rate. We employed 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 (46,243 pregnant women). Operative treatment significantly reduced the composite of adverse pregnancy outcomes (OR 0.56; 95% CI 0.35 to 0.90) and length of hospital stay (MD -7.15; 95% CI -7.83 to -6.47) compared to nonoperative treatment. Additionally, operative treatment had a trend toward reduced readmission rate (OR 0.15; 95% CI 0.02 to 1.03). However, maternal mortality (OR 0.78; 95% CI 0.32 to 1.93), pregnancy loss (OR 1.21; 95% CI 0.66 to 2.22), and preterm delivery (OR 0.64; 95% CI 0.32 to 1.30) 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 rates.
CONCLUSION: Cholecystectomy should be the preferred treatment for pregnant patients with acute cholecystitis, as it reduces adverse pregnancy outcomes, shortens hospital stays, and potentially reduces preterm delivery and readmission rates.
Figure 1. Forest Plot of
(A) maternal mortality and
(B) adverse pregnancy outcomes.
Figure 2. Forest Plot of
(A) preterm delivery,
(B) pregnancy loss,
(C) readmission rate, and
(D) length of hospital stay.
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