118 The Rolling Stones: A Systematic Review and Meta-Analysis of the Management of Gallstone Ileus
Bibliographic record
Abstract
Abstract Aim Gallstone ileus is a rare but serious complication caused by gallstones entering the gastrointestinal tract, often necessitating surgical intervention. Surgical options include enterolithotomy alone, enterolithotomy combined with cholecystectomy, and enterolithotomy with fistula closure. However, there is no consensus on which approach yields the best outcomes regarding mortality, morbidity, and operative time. This systematic review and meta-analysis aimed to compare these surgical strategies. Method Following PRISMA guidelines, a systematic literature search was performed across Ovid MEDLINE, Embase, and PubMed for studies published after 2000. Two reviewers independently screened eligible studies and extracted relevant data. Study quality was appraised using the Newcastle-Ottawa Scale. Ten studies including 293 patients were included. Primary outcomes analysed were mortality and morbidity; secondary outcome was operative time. Pooled odds ratios (ORs) and mean differences (MDs) were calculated using fixed- and random-effects meta-analyses. Statistical heterogeneity was assessed using I² and τ² statistics. Subgroup analyses explored differences among surgical approaches. Results Combined enterolithotomy and cholecystectomy was associated with significantly lower mortality (OR: 2.39; 95% CI: 1.87–3.04; I² = 33%) compared to enterolithotomy alone (OR: 3.09; 95% CI: 1.36–7.02; I² = 69%). Enterolithotomy with fistula repair demonstrated the highest morbidity risk (OR: 4.92; 95% CI: 3.38–7.14; I² = 0%). Operative time was significantly longer for combined procedures (MD: 62.47 minutes; 95% CI: 60.14–64.81). Subgroup differences were statistically significant (p < 0.01). Conclusions Enterolithotomy combined with cholecystectomy may improve mortality despite increased operative duration. These findings support tailored surgical approaches and highlight the need for prospective studies to determine optimal management.
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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 | 0.012 | 0.027 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.022 | 0.039 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| 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".