“My pregnant wife has been recommended gall bladder removal surgery. When can we do it?”

I have had to laparoscopically operate on many pregnant women. A major attack of pain that resolves will most likely return. Risk of surgery with early delivery is noted in the first 3 months. This tends to slow down during the second trimester. We try to schedule these patients during this period. Doing any surgery in the last trimester is difficult to do laparoscopically. Open procedure is required.

Wait until she delivers.

It is better to perform it after delivery. If there is no urgent condition to remove it, you should wait until after the delivery.

3-6 months would be the ideal time, but if truly an issue, can be done emergently whenever

I would try to wait for after delivery if possible

Gallbladder disease this early in the pregnancy has an extremely high chance to NOT get better and create a risk for miscarriage. Although there is some risk, the best option is to have a laparoscopic cholecystectomy. This is easily verifiable and under SAGES guidelines.

The best thing would be if she could get through the pregnancy and have it removed shortly after. This is if she is able to tolerate an adequate diet and through the pregnancy without having attacks of biliary colick, emesis, and/or cholecystitis. If this is not the case, the best time to operate is in the second trimester when most of the development is already completed and the baby and uterus are not so large as to be obstructive.

Actually now is the time to have the gallbladder removed for several reasons.

First, it’s best not to have general anesthesia during the first trimester because the fetus is developing. At 3 months, your wife should be out of her first trimester or close to it (>14 weeks).

Next, let’s skip ahead and talk about the 3rd trimester. In the 3rd trimester the uterus is so enlarged with the fetus that elective abdominal surgery becomes more difficult. It’s best to do gallbladder surgery laparoscopically. With an enlarged uterus and baby in the way, no surgeon should really be doing laparoscopic surgery in the 3rd trimester, although there are always exceptions. The anatomy of the internal organs can also be somewhat distorted because of the enlarged uterus. Granted your wife has a gallbladder issue, but just to make a point, the appendix can be in the right upper abdomen in the 3rd trimester instead of the right lower abdomen. During the 3rd trimester, the weight of the enlarged uterus and baby also puts a lot of pressure on they inferior vena cava and can inhibit blood flow to the mother when she is lying on the operating room table and paralyzed, as with gallbladder surgery. A surgeon should place a pregnant patient titled on the operating room table to keep the uterus off the vena cava, but that can make surgery more difficult as well with the patient tilted, again another reason why 3rd trimester surgery can be difficult. Last, in 3rd trimester any strain on the mother could lead to pre-terms labor. General anesthesia and surgery is such a strain. The baby will also have to be under intense fetal monitoring during the operation with her OB doctor and many women will be managed by high risk OB doctors in the peri-operative period.

The 2nd trimester is best for elective surgery during pregnancy because it doesn’t have the same risks as 1st or 3rd trimester surgery. For the reasons I mentioned above. The fetus is for the most part all developed, ie the baby has its parts, it’s just all growing in size. And, there is room in the mother’s abdomen for the surgery to do their thing. In this case, the gallbladder can be done laparoscopically. I recommend you have your wife see a experience general surgeon to get her gallbladder removed soon. And like I said, it should be done laparoscopically, no need to do open, but of course I’m not the one examining your wife so that has to be taken in to consideration, in addition to her other medical and surgical history.

Hope this helps.

Usually we like to wait until the baby has been delivered before we remove the gallbladder, but if symptoms are intolerable or if a patient has complications then it is necessary to remove the gallbladder sooner. With current surgical techniques it is usually safe to do during pregnancy. The timing is important because as the uterus enlarges, it makes it more difficult to perform the surgery laparoscopically and she may need an open operation.

That depends on the kind of complication. The best would be after birth of your child. If surgery is needed urgently, it should be done open, not laparoscopic.

She can have Lap surgery.

Depending on what the complications are with the gallbladder, your wife should have the surgery either as soon as possible, or at the least during the second trimester. New guidelines about surgery during pregnancy have been released, and because of the high incidence of recurrent complications with gallstones and the risk to the baby as a result, the recommendations are now that the gallbladder should be removed as soon as it is symptomatic if it is infected (acute cholecystitis), or during the second trimester if things can be temporized until then (something along the lines of choledocholithiasis, which is gallstones in the common bile duct instead of in the gallbladder). After the second trimester, surgery becomes technically more challenging and less likely to be successfully completed laparoscopically (or minimally invasively).

It’s best to wait after the delivery. However if she is very symptomatic, the second trimester is the best time to get it done.

In general, if symptoms from gallstones are such that the pregnant female cannot wait until she completes her pregnancy, the second trimester is the best time to operate. That would be from the 13th- 28th week.

It is ideal to wait until after the pregnancy to operate. If surgery is necessary, the second trimester (months 4-6) is the best time to operate as it is safest for the baby. Surgery can still likely be done via a minimally invasive approach (laparoscopically).