Percutaneous vs. surgical management in acute cholecystitis: addressing selection bias in meta-analyses

This commentary addresses the recent research titled "Comparing percutaneous treatment and cholecystectomy outcomes in acute cholecystitis patients: a systematic review and meta-analysis" published in the World Journal of Emergency Surgery. The review confirms that cholecystectomy (CC), particularly laparoscopic, is associated with lower mortality and readmission rates compared to percutaneous cholecystostomy (PC). However, this commentary emphasizes that the interpretation of these findings must account for inherent selection bias: in clinical practice, PC is typically reserved for higher-risk patients who are unfit for immediate surgery. Thus, the observed outcome differences partially reflect disparities in baseline risk rather than therapeutic efficacy alone. The review's true value lies in reinforcing early CC as the standard of care for suitable patients and clarifying the role of PC as a "bridge therapy" to stabilize patients for subsequent definitive surgery. Future research should focus on optimizing risk stratification and timing of delayed CC after PC.