Major Hepatobiliary Surgery during Pregnancy: Safety and Timing

Abstract

Hepatobiliary disease, although rare, may present during pregnancy with potential complications for mother and fetus. We present two cases of choledochal cysts and one case of a hepatic adenoma diagnosed in gravid patients. All three patients had acute events or failed medical management and were successfully treated with open resection, excision, or reconstruction during the second or third trimesters of pregnancy without requiring blood transfusions or tocolytic therapy. Although conservative treatment may be indicated in select patients due to the risk of underlying disease, we recommend surgical treatment preferably in the second trimester. With diligent intra- and postoperative management, pregnant patients can safely proceed with major hepatobiliary surgery.

Behavior and complications of hepatocellular adenoma during pregnancy and puerperium: a retrospective study and systematic review

“…Elective, uncomplicated, hepatic resections were performed up to the second trimester. 27,28,37,38,42,51 No minimally invasive strategy was identified as superior due to limited observations. Three patients were treated by US-guided RFA: two during pregnancy (patients 2 & 75) and one prior to the second pregnancy (patient 9-2).…”

Updates on The Management of Hepatocellular Adenomas

“…Women with larger tumors or tumors with highrisk features are encouraged to undergo surgical resection before a planned pregnancy. The second trimester is the safest time for the mother and the baby for elective surgery [34]. There are reports of trans-arterial embolization of large HCAs in the third trimester with satisfactory results Pregnant patients with HCAs should have an ul-trasound of the liver every 3 months during pregnancy.…”

Surgical Emergencies in the Pregnant Patient

“…However, pregnancy is also associated with adenoma growth and risk of rupture. 31 Right upper quadrant pain should be evaluated with ultrasound. Although a cystic structure requires no immediate follow-up, a solid mass requires a non-contrasted MRI.…”