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Study flow diagram.
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Figure 1

Study flow diagram.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Early or delayed laparoscopic cholecystectomy for biliary colic, Outcome 1 Mortality.
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Analysis 1.1

Comparison 1 Early or delayed laparoscopic cholecystectomy for biliary colic, Outcome 1 Mortality.

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Comparison 1 Early or delayed laparoscopic cholecystectomy for biliary colic, Outcome 2 Serious adverse events.
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Analysis 1.2

Comparison 1 Early or delayed laparoscopic cholecystectomy for biliary colic, Outcome 2 Serious adverse events.

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Comparison 1 Early or delayed laparoscopic cholecystectomy for biliary colic, Outcome 3 Conversion to open cholecystectomy.
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Analysis 1.3

Comparison 1 Early or delayed laparoscopic cholecystectomy for biliary colic, Outcome 3 Conversion to open cholecystectomy.

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Comparison 1 Early or delayed laparoscopic cholecystectomy for biliary colic, Outcome 4 Hospital stay (days).
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Analysis 1.4

Comparison 1 Early or delayed laparoscopic cholecystectomy for biliary colic, Outcome 4 Hospital stay (days).

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Comparison 1 Early or delayed laparoscopic cholecystectomy for biliary colic, Outcome 5 Operating time (minutes).
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Analysis 1.5

Comparison 1 Early or delayed laparoscopic cholecystectomy for biliary colic, Outcome 5 Operating time (minutes).

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Summary of findings for the main comparison. Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic

Early laparoscopic cholecystectomy compared to delayed laparoscopic cholecystectomy for uncomplicated biliary colic

Patient or population: participants with biliary colic.
Settings: secondary or tertiary.
Intervention: early laparoscopic cholecystectomy.
Comparison: delayed laparoscopic cholecystectomy.

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Delayed laparoscopic cholecystectomy

Early laparoscopic cholecystectomy

Mortality

25 per 1000

9 per 1000
(0 to 226)

RR 0.38
(0.02 to 9.03)

75
(1 study)

⊕⊝⊝⊝
very low1,2,3

Serious adverse events

225 per 1000

16 per 1000
(0 to 277)

RR 0.07
(0 to 1.23)

68
(1 study)

⊕⊝⊝⊝
very low1,3

Conversion to open cholecystectomy

171 per 1000

17 per 1000
(2 to 279)

RR 0.1
(0.01 to 1.63)

63
(1 study)

⊕⊝⊝⊝
very low1,2,3

Hospital stay (days)

The mean hospital stay (days) in the control groups was
2.31 days

The mean hospital stay (days) in the intervention groups was
1.25 lower
(2.05 to 0.45 lower)

63
(1 study)

⊕⊝⊝⊝
very low1,4

Operating time (minutes)

The mean operating time (minutes) in the control groups was
49.9 minutes

The mean operating time (minutes) in the intervention groups was
14.8 lower
(18.02 to 11.58 lower)

63
(1 study)

⊕⊝⊝⊝
very low1,4

*The basis for the assumed risk is the median control group risk in the study. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 The trial was at high risk of bias.
2 The confidence intervals overlapped 1 and either 0.75 or 1.25 or both.
3 The number of events in the intervention and control group was fewer than 300.
4 The total number of participants in the intervention and control group was fewer than 400.

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Summary of findings for the main comparison. Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic
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Comparison 1. Early or delayed laparoscopic cholecystectomy for biliary colic

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

1

75

Risk Ratio (M‐H, Fixed, 95% CI)

0.38 [0.02, 9.03]

2 Serious adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3 Conversion to open cholecystectomy Show forest plot

1

63

Risk Ratio (M‐H, Fixed, 95% CI)

0.10 [0.01, 1.63]

4 Hospital stay (days) Show forest plot

1

63

Mean Difference (IV, Fixed, 95% CI)

‐1.25 [‐2.05, ‐0.45]

5 Operating time (minutes) Show forest plot

1

63

Mean Difference (IV, Fixed, 95% CI)

‐14.80 [‐18.02, ‐11.58]
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Comparison 1. Early or delayed laparoscopic cholecystectomy for biliary colic
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