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.
- gallstone disease
Data availability statement
No data are available. All the data is available in the online supplementary material.
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Contributors BSB: conceptualisation, data curation, formal analysis, inputs on original draft Investigation, methodology, software, review and editing. MH: conceptualisation, data curation, formal analysis, original draft. AS: data curation, review and editing. KVJ: data curation, review and editing. NKO: critical review and editing.
Funding The HTA resource centre ICMR-NIE is funded by the Department of Health Research Government of India.
Disclaimer Funders had no role in the conceptualisation, study conduction and manuscript preparation.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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