Restrictive Strategy for Gallstone Surgery Does Not Change Five-Year Outcomes

THURSDAY, Aug. 29, 2024 (HealthDay News) — In patients with abdominal pain and gallstones, a more restrictive approach may avoid unnecessary cholecystectomies, with no difference in five-year outcomes, according to a study published online Aug. 21 in JAMA Surgery.

Daan J. Comes, M.D., from Radboud University Medical Centre in Nijmegen, Netherlands, and colleagues evaluated the long-term impact of restrictive selection or usual care for cholecystectomy in patients with symptomatic cholelithiasis. Persistent pain and biliary and surgical complications were evaluated at five-year follow-up for 1,067 patients.

The researchers found that at follow-up, 62.8 percent of patients were pain-free in the usual care group versus 61.2 percent in the restrictive strategy group. Similar percentages were pain-free after cholecystectomy (63.6 percent in the usual care group versus 63.0 percent in the restrictive strategy group). The number of patients receiving cholecystectomies was lower with the restrictive care strategy (73.2 percent) versus usual care (81.5 percent). There were no differences between the groups for biliary and surgical complications or for patient satisfaction.

“Regardless of the strategy, only two-thirds of patients were pain-free,” the authors write. “Further criteria for selecting patients with uncomplicated cholelithiasis for cholecystectomy and rethinking laparoscopic cholecystectomy as treatment is needed to improve patient-reported outcomes.”

Abstract/Full Text