Long-term outcomes after open cholecystectomy are largely unknown. We aimed to investigate long-term mortality rate and incidence of intestinal obstruction after open cholecystectomy. Reporting of this systematic review and meta-analysis was according to the PRISMA 2020 guideline. A protocol was registered at PROSPERO (CRD42020178906). We searched the databases PubMed, Embase, and Cochrane CENTRAL in February 2022 for studies on long-term complications with n > 40 and follow-up ≥ 6 months. Outcomes included mortality and intestinal obstruction. Meta-analyses were conducted, and results were presented in forest plots. Risk of bias was assessed with the Newcastle–Ottawa Scale or Cochrane risk-of-bias tool 1. We included 21 studies. Long-term mortality after open cholecystectomy was reported in 17 studies including 125,222 patients, and it ranged from 0–35%. Follow-up ranged from six months to ten years. Meta-analysis estimated a long-term mortality rate of 9.2% (95% CI 6.8–11.6). One study with 90 patients reported on mini-laparotomy and none died during the 12 months follow-up. Three studies with 66,257 patients reported on intestinal obstruction after open cholecystectomy with an incidence ranging from 0.5% to 2.6%. Follow-up ranged from 36 to 67 months. Meta-analysis estimated a long-term rate of intestinal obstruction of 2.0% (95% CI 1.0–3.0). After a follow-up of six months to ten years, long-term mortality was 9.2%, and long-term incidence of intestinal obstruction was 2% up to 67 months after open cholecystectomy.