Conservative Management Versus Early Cholecystectomy for Gallstone Disease: A Meta-Analysis of Randomized Controlled Trials.

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.