Gallstone disease affects a significant portion of the population, and its treatment traditionally involves surgical removal of the gallbladder, known as a laparoscopic cholecystectomy. However, this new research offers a comparison between surgery and conservative management to assess whether surgery is necessary in all cases of uncomplicated gallstone disease.
Researchers conducted a randomized trial across 20 secondary care centers in the UK, involving 434 participants. The aim was to determine the effectiveness of conservative management in preventing recurring symptoms and complications, compared to surgery. “We wanted to see if patients could avoid surgery without compromising their quality of life,” explains Dr. Irfan Ahmed, the study’s lead author.
The results showed that 67% of patients in the surgical group underwent a cholecystectomy within 18 months, while only 25% of the conservative management group eventually required surgery. Despite this, the quality of life scores, measured using the SF-36 bodily pain scale, were nearly identical between both groups, with no significant difference in pain or overall well-being at the 18-month mark. “Our findings suggest that many patients could avoid surgery and its associated risks without impacting their recovery or quality of life,” says Ahmed.
In terms of cost, the conservative management group incurred lower healthcare costs. The National Health Service (NHS) saved approximately £1,033 per patient by avoiding surgery in cases where it was not needed. From a public health perspective, this could lead to substantial savings. “When you consider the burden gallstone disease places on the healthcare system, these savings could be significant,” adds Dr. Karen Innes, a co-researcher.
While the study primarily focuses on the 18-month outcomes, it highlights the need for further long-term research. “We expect that the long-term data will provide even more insights into which patients benefit most from conservative management and who might need surgery later on,” says Dr. Rebecca Bruce, another key member of the research team.
The study underlines that conservative management should be considered a valid alternative for uncomplicated symptomatic gallstone disease. “By avoiding unnecessary surgeries, we not only reduce costs but also spare patients from potential surgical complications,” concludes Dr. Ahmed.
Citation:
Ahmed I, Hudson J, Innes K, et al. Effectiveness of conservative management versus laparoscopic cholecystectomy in the prevention of recurrent symptoms and complications in adults with uncomplicated symptomatic gallstone disease (C-GALL trial): pragmatic, multicentre randomised controlled trial. BMJ. 2023;383.
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