As aforementioned, cirrhosis is a relative contraindication to cholecystectomy because bleeding from the diseased liver parenchyma as the gallbladder is dissected can be difficult to control. This bleeding problem is compounded by portal venous hypertension and coagulation abnormalities from reduced liver synthetic function. In the event that bleeding from the gallbladder fossa cannot be satisfactorily controlled, the only option may be to decrease portal hypertension with a portal-systemic shunt of some sort (usually a TIPS).
Surgical treatment of biliary colic in pregnant patients is usually deferred until the postpartum period unless symptoms are too severe or there is gestational weight loss. When cholecystectomy is to be undertaken, the second trimester is typically the preferred time. Miscarriage rates are lower in the second than the first trimester and preterm labor rates are lower in the second than third trimester. Modern series of pregnant patients with biliary pancreatitis, however, have challenged the notion that the second trimester should be the preferred time for biliary surgery or that it should carry significant maternal or fetal risk. Cholecystectomy may prove to be a safe procedure at any time during pregnancy so long as obstetric involvement is obtained early and fetal monitoring is performed (22).
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