Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy

Bhavani Shankara Bagepally, Madhumitha Haridoss, Akhil Sasidharan, Kayala Venkata Jagadeesh, Nikhil Kumar Oswal, Bhavani Shankara Bagepally, Madhumitha Haridoss, Akhil Sasidharan, Kayala Venkata Jagadeesh, Nikhil Kumar Oswal

Abstract

Background: The effectiveness of early cholecystectomy for gallstone diseases treatment is uncertain compared with conservative management/delayed cholecystectomy.

Aims: To synthesise treatment outcomes of early cholecystectomy versus conservative management/delayed cholecystectomy in terms of its safety and effectiveness.

Design: We systematically searched randomised control trials investigating the effectiveness of early cholecystectomy compared with conservative management/delayed cholecystectomy. We pooled the risk ratios with a 95% CI, also estimated adjusted number needed to treat to harm.

Results: Of the 40 included studies for systematic review, 39 studies with 4483 patients are included in meta-analysis. Among the risk ratios of gallstone complications, pain (0.38, 0.20 to 0.74), cholangitis (0.52, 0.28 to 0.97) and total biliary complications (0.33, 0.20 to 0.55) are significantly lower with early cholecystectomy. Adjusted number needed to treat to harm of early cholecystectomy compared with conservative management/delayed cholecystectomy are, for pain 12.5 (8.3 to 33.3), biliary pancreatitis >1000 (50-100), common bile duct stones 100 (33.3 to 100), cholangitis (100 (25-100), total biliary complications 5.9 (4.3 to 9.1) and mortality >1000 (100 to100 000).

Conclusions: Early cholecystectomy may result in fewer biliary complications and a reduction in reported abdominal pain than conservative management.

Prospero registration number: 2020 CRD42020192612.

Keywords: cholecystectomy; gallstone disease; meta-analysis.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of study selection.
Figure 2
Figure 2
Forest plot showing risk ratio of total biliary complications between early cholecystectomy and conservative management/delayed cholecystectomy with subgroups. CM, conservative management; DC, delayed cholecystectomy; EC, early cholecystectomy.
Figure 3
Figure 3
Forest plot showing mean difference in length of hospital stay between early and delayed cholecystectomy. DC, delayed cholecystectomy; EC, early cholecystectomy.

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