{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:38:14Z","timestamp":1780544294094,"version":"3.54.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Symptomatic biliary disease frequently prompts patients to seek medical care during pregnancy. Most guidelines now recommend prompt surgical intervention regardless of trimester for complicated biliary disease during pregnancy (i.e., acute cholecystitis, choledocholithiasis, cholangitis, and gallstone pancreatitis). We investigated our health system\u2019s experience with the care of this patient population in the context of current recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The electronic medical record of a large, multi-hospital health system was queried from January 2017 to December 2024 for all patients with diagnoses of pregnancy and complicated biliary disease. Patients were divided into 4 groups based on trimester at time of procedural intervention or postpartum management. Patients in the postpartum group presented with symptomatic biliary disease during their pregnancy and progressed to complicated disease within three months after delivery, necessitating procedural intervention in that period of time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The search yielded 48 patients: 7 first trimester, 22 s, 5 third, and 14 postpartum. Procedural interventions included ERCPs and laparoscopic cholecystectomies. All cholecystectomies were completed without major surgical morbidity. Most interventions occurred in the second trimester or postpartum (75%). Surgical outcomes were similar across all groups; any variability in proportions was attributable to low sample sizes. Parental-fetal outcomes, including incidence of preeclampsia, pregnancy loss, and preterm delivery, were similar across groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our analysis confirms that procedural interventions for complicated biliary disease are safe to perform regardless of trimester. Our work also demonstrates the difficulties of studying this disease process as the prevalence is relatively low. This area of study could benefit from multi-institutional collaboration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-025-12329-5","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T16:59:18Z","timestamp":1762189158000},"page":"629-636","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Complicated biliary disease during pregnancy: a retrospective cohort analysis from a tertiary care\u00a0facility"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9596-0432","authenticated-orcid":false,"given":"Amrita","family":"Iyer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunjay","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Muti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Manca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami","family":"Tannouri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talar","family":"Tatarian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Berghella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Palazzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"12329_CR1","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1097\/00003081-199406000-00008","volume":"37","author":"HT Sharp","year":"1994","unstructured":"Sharp HT (1994) Gastrointestinal surgical conditions during pregnancy. Clin Obstet Gynecol 37:306\u2013315","journal-title":"Clin Obstet Gynecol"},{"key":"12329_CR2","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/S1665-2681(19)32018-6","volume":"5","author":"N Mendez-Sanchez","year":"2006","unstructured":"Mendez-Sanchez N, Chavez-Tapia NC, Uribe M (2006) Pregnancy and gallbladder disease. Ann Hepatol 5:227\u2013230","journal-title":"Ann Hepatol"},{"key":"12329_CR3","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1016\/j.amjsurg.2008.01.015","volume":"196","author":"RS Date","year":"2008","unstructured":"Date RS, Kaushal M, Ramesh A (2008) A review of the management of gallstone disease and its complications in pregnancy. Am J Surg 196:599\u2013608","journal-title":"Am J Surg"},{"key":"12329_CR4","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1097\/AOG.0000000000002748","volume":"132","author":"MC Tolcher","year":"2018","unstructured":"Tolcher MC, Fisher WE, Clark SL (2018) Nonobstetric surgery during pregnancy. Obstet Gynecol 132:395\u2013403","journal-title":"Obstet Gynecol"},{"key":"12329_CR5","doi-asserted-by":"publisher","unstructured":"Martin JA, Hamilton BE, Osterman MJK (2024) Births in the United States, 2023. NCHS Data Brief, https:\/\/doi.org\/10.15620\/cdc\/158789","DOI":"10.15620\/cdc\/158789"},{"key":"12329_CR6","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1097\/GRF.0000000000000496","volume":"63","author":"KE Brown","year":"2020","unstructured":"Brown KE, Hirshberg JS, Conner SN (2020) Gallbladder and biliary disease in pregnancy. Clin Obstet Gynecol 63:211\u2013225","journal-title":"Clin Obstet Gynecol"},{"key":"12329_CR7","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1515\/jpm-2017-0085","volume":"46","author":"A El-Messidi","year":"2018","unstructured":"El-Messidi A, Alsarraj G, Czuzoj-Shulman N, Mishkin DS, Abenhaim HA (2018) Evaluation of management and surgical outcomes in pregnancies complicated by acute cholecystitis. J Perinat Med 46:998\u20131003","journal-title":"J Perinat Med"},{"key":"12329_CR8","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1097\/SLA.0000000000004210","volume":"272","author":"AJ Rios-Diaz","year":"2020","unstructured":"Rios-Diaz AJ, Oliver EA, Bevilacqua LA, Metcalfe D, Yeo CJ, Berghella V, Palazzo F (2020) Is it safe to manage acute cholecystitis nonoperatively during pregnancy? A nationwide analysis of morbidity according to management strategy. Ann Surg 272:449\u2013456","journal-title":"Ann Surg"},{"key":"12329_CR9","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.jamcollsurg.2021.03.034","volume":"233","author":"V Cheng","year":"2021","unstructured":"Cheng V, Matsushima K, Ashbrook M, Matsuo K, Schellenberg M, Inaba K, Sandhu K (2021) Association between trimester and outcomes after cholecystectomy during pregnancy. J Am Coll Surg 233:29-37.e1","journal-title":"J Am Coll Surg"},{"key":"12329_CR10","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1097\/SLA.0000000000001976","volume":"266","author":"V Balinskaite","year":"2017","unstructured":"Balinskaite V, Bottle A, Sodhi V, Rivers A, Bennett PR, Brett SJ, Aylin P (2017) The risk of adverse pregnancy outcomes following nonobstetric surgery during pregnancy: estimates from a retrospective cohort study of 6.5 million pregnancies. Ann Surg 266:260\u2013266","journal-title":"Ann Surg"},{"key":"12329_CR11","first-page":"1016","volume":"52","author":"J Hedstr\u00f6m","year":"2017","unstructured":"Hedstr\u00f6m J, Nilsson J, Andersson R, Andersson B (2017) Changing management of gallstone-related disease in pregnancy - a retrospective cohort analysis. Scand J Gastroenterol 52:1016\u20131021","journal-title":"Scand J Gastroenterol"},{"key":"12329_CR12","doi-asserted-by":"publisher","first-page":"2947","DOI":"10.1007\/s00464-024-10810-1","volume":"38","author":"SS Kumar","year":"2024","unstructured":"Kumar SS, Collings AT, Wunker C, Athanasiadis DI, DeLong CG, Hong JS, Ansari MT, Abou-Setta A, Oliver E, Berghella V, Alli V, Hassan I, Hollands C, Sylla P, Slater BJ, Palazzo F (2024) SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 38:2947\u20132963","journal-title":"Surg Endosc"},{"key":"12329_CR13","doi-asserted-by":"crossref","unstructured":"(2019) ACOG committee opinion no. 775: nonobstetric surgery during pregnancy. Obstet Gynecol 133:e285\u2013e286. https:\/\/pubmed.ncbi.nlm.nih.gov\/30913200\/","DOI":"10.1097\/AOG.0000000000003174"},{"key":"12329_CR14","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1001\/jamasurg.2020.3683","volume":"155","author":"SJ Schwulst","year":"2020","unstructured":"Schwulst SJ, Son M (2020) Management of gallstone disease during pregnancy. JAMA Surg 155:1162\u20131163","journal-title":"JAMA Surg"},{"key":"12329_CR15","doi-asserted-by":"publisher","first-page":"3479","DOI":"10.1007\/s00464-011-1927-3","volume":"25","author":"Pearl J, Price R, Richardson W, Fanelli R, Society of American Gastrointestinal Endoscopic Surgeons","year":"2011","unstructured":"Pearl J, Price R, Richardson W, Fanelli R, Society of American Gastrointestinal Endoscopic Surgeons (2011) Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 25:3479\u20133492","journal-title":"Surg Endosc"},{"key":"12329_CR16","doi-asserted-by":"publisher","first-page":"3767","DOI":"10.1007\/s00464-017-5637-3","volume":"31","author":"JP Pearl","year":"2017","unstructured":"Pearl JP, Price RR, Tonkin AE, Richardson WS, Stefanidis D (2017) SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 31:3767\u20133782","journal-title":"Surg Endosc"},{"key":"12329_CR17","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/j.surg.2009.03.033","volume":"146","author":"S Kuy","year":"2009","unstructured":"Kuy S, Roman SA, Desai R, Sosa JA (2009) Outcomes following cholecystectomy in pregnant and nonpregnant women. Surgery 146:358\u2013366","journal-title":"Surgery"},{"key":"12329_CR18","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1007\/s00464-009-0544-x","volume":"24","author":"R Dhupar","year":"2010","unstructured":"Dhupar R, Smaldone GM, Hamad GG (2010) Is there a benefit to delaying cholecystectomy for symptomatic gallbladder disease during pregnancy? Surg Endosc 24:108\u2013112","journal-title":"Surg Endosc"},{"key":"12329_CR19","volume":"15","author":"X Nan","year":"2023","unstructured":"Nan X, Chan E, Wong KSC, Ng J, Izwan S, Cooper M, Damodaran R (2023) Laparoscopic cholecystectomy in pregnancy: a seven-year retrospective study from an Australian tertiary center. Cureus 15:e50034","journal-title":"Cureus"},{"key":"12329_CR20","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1016\/j.amjsurg.2004.09.002","volume":"188","author":"EJ Lu","year":"2004","unstructured":"Lu EJ, Curet MJ, El-Sayed YY, Kirkwood KS (2004) Medical versus surgical management of biliary tract disease in pregnancy. Am J Surg 188:755\u2013759","journal-title":"Am J Surg"},{"key":"12329_CR21","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1016\/j.gie.2012.04.475","volume":"76","author":"MO Othman","year":"2012","unstructured":"Othman MO, Stone E, Hashimi M, Parasher G (2012) Conservative management of cholelithiasis and its complications in pregnancy is associated with recurrent symptoms and more emergency department visits. Gastrointest Endosc 76:564\u2013569","journal-title":"Gastrointest Endosc"},{"key":"12329_CR22","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1002\/jhbp.512","volume":"25","author":"S Kiriyama","year":"2018","unstructured":"Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, Hata J, Liau K-H, Miura F, Horiguchi A, Liu K-H, Su C-H, Wada K, Jagannath P, Itoi T, Gouma DJ, Mori Y, Mukai S, Gim\u00e9nez ME, Huang WS-W, Kim M-H, Okamoto K, Belli G, Dervenis C, Chan ACW, Lau WY, Endo I, Gomi H, Yoshida M, Mayumi T, Baron TH, de Santiba\u00f1es E, Teoh AYB, Hwang T-L, Ker C-G, Chen M-F, Han H-S, Yoon Y-S, Choi I-S, Yoon D-S, Higuchi R, Kitano S, Inomata M, Deziel DJ, Jonas E, Hirata K, Sumiyama Y, Inui K, Yamamoto M (2018) Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 25:17\u201330","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"12329_CR23","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","volume":"62","author":"PA Banks","year":"2013","unstructured":"Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS, Acute Pancreatitis Classification Working Group (2013) Classification of acute pancreatitis\u20132012: revision of the Atlanta classification and definitions by international consensus. Gut 62:102\u2013111","journal-title":"Gut"},{"key":"12329_CR24","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1001\/jamasurg.2023.5803","volume":"159","author":"MN Hantouli","year":"2024","unstructured":"Hantouli MN, Droullard DJ, Nash MG, Benson LS, Wright AS, Flum DR, Davidson GH (2024) Operative vs nonoperative management of acute cholecystitis during the different trimesters of pregnancy. JAMA Surg 159:28\u201334","journal-title":"JAMA Surg"},{"key":"12329_CR25","doi-asserted-by":"publisher","first-page":"352","DOI":"10.4253\/wjge.v6.i8.352","volume":"6","author":"S Fine","year":"2014","unstructured":"Fine S, Beirne J, Delgi-Esposti S, Habr F (2014) Continued evidence for safety of endoscopic retrograde cholangiopancreatography during pregnancy. World J Gastrointest Endosc 6:352\u2013358","journal-title":"World J Gastrointest Endosc"},{"key":"12329_CR26","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.cgh.2015.04.175","volume":"14","author":"S Inamdar","year":"2016","unstructured":"Inamdar S, Berzin TM, Sejpal DV, Pleskow DK, Chuttani R, Sawhney MS, Trindade AJ (2016) Pregnancy is a risk factor for pancreatitis after endoscopic retrograde cholangiopancreatography in a national cohort study. Clin Gastroenterol Hepatol 14:107\u2013114","journal-title":"Clin Gastroenterol Hepatol"},{"key":"12329_CR27","doi-asserted-by":"publisher","first-page":"4707","DOI":"10.1007\/s00464-025-11926-8","volume":"39","author":"MAB Martins","year":"2025","unstructured":"Martins MAB, Meine GC, Gadelha JG, Sousa AGE, Masiero BB, Figueiredo SMP (2025) Operative versus nonoperative treatment of acute cholecystitis during pregnancy: a systematic review and meta-analysis. Surg Endosc 39:4707\u20134715","journal-title":"Surg Endosc"},{"key":"12329_CR28","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1007\/s11605-015-2757-8","volume":"19","author":"AM Jorge","year":"2015","unstructured":"Jorge AM, Keswani RN, Veerappan A, Soper NJ, Gawron AJ (2015) Non-operative management of symptomatic cholelithiasis in pregnancy is associated with frequent hospitalizations. J Gastrointest Surg 19:598\u2013603","journal-title":"J Gastrointest Surg"},{"key":"12329_CR29","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1016\/j.jamcollsurg.2018.12.024","volume":"228","author":"ZV Fong","year":"2019","unstructured":"Fong ZV, Pitt HA, Strasberg SM, Molina RL, Perez NP, Kelleher CM, Loehrer AP, Sicklick JK, Talamini MA, Lillemoe KD, Chang DC, California Cholecystectomy Group (2019) Cholecystectomy during the third trimester of pregnancy: proceed or delay? J Am Coll Surg 228:494-502.e1","journal-title":"J Am Coll Surg"},{"key":"12329_CR30","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1097\/AOG.0000000000002740","volume":"132","author":"Y-Y Juo","year":"2018","unstructured":"Juo Y-Y, Khrucharoen U, Sanaiha Y, Seo Y-J, Dutson E, Benharash P (2018) Cumulative financial burden of readmissions for biliary pancreatitis in pregnant women. Obstet Gynecol 132:415\u2013422","journal-title":"Obstet Gynecol"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-025-12329-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-025-12329-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-025-12329-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T19:33:22Z","timestamp":1769024002000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-025-12329-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,3]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["12329"],"URL":"https:\/\/doi.org\/10.1007\/s00464-025-12329-5","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,3]]},"assertion":[{"value":"15 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Amrita Iyer, Dr. Sunjay Kumar, Isabella Muti, Edoardo Manca, Dr. Sami Tannouri, Dr. Talar Tatarian, Dr. Vincenzo Berghella, and Dr. Francesco Palazzo have no conflicts of interest or financial ties to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}