118 The Rolling Stones: A Systematic Review and Meta-Analysis of the Management of Gallstone Ileus

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.