Long-term patient-reported outcomes following initial non-operative management of uncomplicated gallstone disease

Abstract Background Conservative management is commonly used for selected patients with symptomatic, uncomplicated gallstone disease and mild symptoms. However, long-term patient-reported outcomes after an initial non-operative strategy remain poorly described. This study aimed to evaluate long-term symptoms, quality of life, and delayed cholecystectomy after initial conservative management. Methods This retrospective cohort study with prospective patient-reported follow-up included adults with uncomplicated gallstone disease initially managed without cholecystectomy at a Danish university hospital between 2010 and 2019. Follow-up questionnaires were distributed in 2023, and cholecystectomy status was verified through medical record review. Results Among 688 eligible patients, 481 (69.9%) responded after a median follow-up of 8.9 years. Overall, 325 patients (67.6%) remained non-operated, of whom 100 (30.8%) reported persistent gallstone-related pain. A total of 156 patients (32.4%) underwent delayed cholecystectomy after a median of 1.3 years, including 35 (22.4%) emergency cholecystectomies. Persistent gallstone-related pain was reported less frequently among patients undergoing delayed cholecystectomy than among those remaining non-operated (20.5% vs. 30.8%; OR 0.58, 95% CI 0.37–0.91; p = 0.02). Overall, 256/481 (53.2%) responders had either undergone delayed cholecystectomy or remained non-operated with persistent gallstone-related pain, whereas 225/481 (46.8%) remained non-operated without persistent pain. Conclusions At long-term follow-up after initial non-operative management of uncomplicated gallstone disease, approximately half of patients had either undergone delayed cholecystectomy or remained non-operated with persistent gallstone-related pain. In contrast, the other half remained non-operated without persistent pain. These findings illustrate the clinical trade-off of an initial conservative strategy and support individualized shared decision-making.