Gallbladder Removal Offers Better Pain Relief in Uncomplicated Gallstones and Mild Cholecystitis: Meta-Analysis Finds
USA: A review of available evidence suggests that cholecystectomy (gallbladder removal surgery) provides superior control of biliary pain compared with conservative management. However, carefully selected patients may be managed conservatively, as this approach is associated with fewer surgical complications and shows similar major clinical outcomes. Further large randomized controlled trials are needed to confirm these findings and help identify the patients most likely to benefit from each strategy.
Gallstone disease affects 10%–25% of the population and is particularly common in women over 40 years of age. Although laparoscopic cholecystectomy is the standard treatment for symptomatic gallstones, conservative management remains an alternative for selected patients, particularly those at higher surgical risk. The optimal approach for uncomplicated gallstones and mild acute cholecystitis, however, remains uncertain.
To address this question, Mahmoud Mohamed Gad and colleagues conducted an updated systematic review and meta-analysis, published in BMC Surgery. The researchers searched major medical databases for randomized controlled trials comparing cholecystectomy with conservative management in adults with uncomplicated gallstones or mild acute cholecystitis. Four trials involving 677 patients were included, with study quality ranging from moderate to high.
The researchers reported the following findings:
- Cholecystectomy significantly reduced the risk of biliary colic compared with conservative management.
- Patients undergoing cholecystectomy experienced fewer recurrent episodes of biliary pain during follow-up.
- Cholecystectomy was associated with a lower risk of overall gallstone-related complications.
- Conservative management resulted in significantly fewer surgery-related complications.
- Patients managed conservatively were less likely to undergo surgical intervention.
- Many patients in the conservative management group were able to avoid or defer surgery during follow-up.
- No significant difference was observed between the two approaches in mortality rates.
- Rates of acute cholecystitis were similar between the cholecystectomy and conservative management groups.
- The risk of acute pancreatitis did not differ significantly between the two treatment strategies.
- The occurrence of common bile duct stones was comparable between the groups.
- Overall, surgery provided better symptom control, while conservative management showed similar outcomes for major clinical complications in selected patients.
The authors noted several limitations, including the small number of trials (four studies involving 677 patients), limited statistical power, and variations in patient characteristics, follow-up duration, and outcome definitions. Inconsistent reporting of delayed surgery, symptom recurrence, quality of life, and patient-reported outcomes also limited the assessment of long-term effects.
Overall, the review found that cholecystectomy is more effective in reducing biliary pain and gallstone-related complications, while conservative management is associated with fewer surgery-related adverse events. The researchers suggested that treatment decisions should be individualized based on symptom severity, surgical risk, patient preference, and available resources, and called for larger multicenter trials to guide definitive recommendations.
Reference:
Gad, M.M., Ayad, Q., Elgamal, M.M. et al. Cholecystectomy versus conservative management for patients with uncomplicated symptomatic gallstones and cholecystitis: an updated systematic review and meta-analysis. BMC Surg 26, 381 (2026). https://doi.org/10.1186/s12893-026-03922-z
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