Conservative Management Versus Early Cholecystectomy for Gallstone Disease: A Meta‐Analysis of Randomized Controlled Trials
Bibliographic record
Abstract
Objective: While most individuals with gallstone disease remain asymptomatic, symptoms of gallstone disease range from biliary pain to acute cholecystitis. Surgery is a popular choice of treatment, but evidence has also suggested conservative management as a safe and viable approach. We aim to investigate the evidence on conservative management versus early cholecystectomy for the management of gallstone disease. Methods: We searched electronic databases to retrieve and include all randomized controlled trials (RCTs) that analyzed the efficacy and safety of conservative management versus early cholecystectomy in the management of gallstone disease. The revised Cochrane "Risk of bias" tool for randomized trials (RoB 2.0) was used to assess the risk of bias in the included studies. We calculated risk ratios (RR) along with the 95% confidence intervals (95% CI) for all the outcomes. The random-effects model was used in our analysis. Results: A total of 11 RCTs were included in our meta-analysis. We found no statistically significant difference between conservative management and early cholecystectomy regarding the incidence of total intraoperative complications (RR 0.45; 95% CI: 0.14-1.42), total postoperative complications (RR 0.85; 95% CI: 0.48-1.50), total surgical complications (RR 0.68; 95% CI: 0.43-1.10), and mortality (RR 1.24; 95% CI: 0.81-1.89). The conservative management group was associated with a statistically significant higher incidence of total biliary complications (RR 3.63; 95% CI: 2.07-6.37), biliary colic (RR 2.75; 95% CI: 1.23-6.15), and common bile duct (CBD) stones (RR 3.96; 95% CI: 1.46-10.71). There was no difference in the incidence of biliary pancreatitis (RR 1.46; 95% CI: 0.49-4.35) and cholangitis (RR 1.52; 95% CI: 0.47-4.89). Conclusion: According to our meta-analysis, conservative management offers no benefit over early cholecystectomy for gallstone disease; it increases the incidence of biliary complications in patients with gallstone disease. More studies are needed to better ascertain the role of conservative management in the management of gallstone disease.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.025 | 0.047 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.025 | 0.052 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".