SynthesisBMC surgery2026
Cholecystectomy versus conservative management for patients with uncomplicated symptomatic gallstones and cholecystitis: an updated systematic review and meta-analysis.
Synthesis in BMC surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
backgroundGallstone disease affects 10-25% of the population, with higher prevalence in women over 40 years of age. Laparoscopic cholecystectomy is the standard treatment for symptomatic or complicated cases. However, it is costly, can cause adverse effects, and can result in post-cholecystectomy syndrome. Conservative management remains an option, especially for high surgical risk patients. The optimal management of uncomplicated gallstones remains controversial. This updated systematic review and meta-analysis incorporates recently published randomized controlled trials (RCTs) comparing the safety and efficacy of cholecystectomy with conservative treatment in symptomatic uncomplicated gallstones and mild acute cholecystitis.
methodsThis systematic review and meta-analysis followed PRISMA guidelines. We searched PubMed, Scopus, Web of Science, and Cochrane Central for RCTs comparing cholecystectomy versus conservative management in adults with uncomplicated gallstones or mild acute cholecystitis. Primary outcomes were biliary colic and overall gallstone-related complications, while secondary outcomes included mortality and surgery-related complications. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using fixed or random effect models based on heterogeneity. Risk of bias was assessed using the Cochrane risk of bias 2.0 (RoB-2) tool, and the certainty of evidence was evaluated using the GRADE approach.
resultsFour RCTs, involving a total of 677 patients, were included. Their quality ranged from moderate to high when assessed by the ROB-2 tool. Cholecystectomy was found to decrease both biliary colic (RR = 0.43, 95% CI [0.24 to 0.78], P = 0.006) and overall gallstone complications (RR = 0.40, 95% CI [0.23 to 0.69], P = 0.0009). However, conservative management was associated with fewer overall surgical complications (RR = 0.40, 95% CI [0.23 to 0.69], P = 0.0009) and the proportion of patients who underwent surgery. Largely because many patients avoided or deferred operative intervention during follow-up. There was no significant difference in mortality, acute cholecystitis, acute pancreatitis, or common bile duct stones between the two groups.
conclusionOur findings suggest that cholecystectomy provides better biliary pain control. However, conservative management may be considered in selected patients due to its lower surgical complication rate and comparable major clinical outcomes. Additional large RCTs are needed to confirm these findings.
trial registrationThe PROSPERO database has the study protocol recorded with ID CRD420250651103.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.