Finding a stone in the gallbladder does not, on its own, mean surgery is needed. If a stone causes attacks of pain or inflammation, removal of the gallbladder is usually recommended. Stones found incidentally that cause no symptoms can often be observed if there are no other problems with the gallbladder or bile ducts.
The decision is not based on the number of stones alone. The nature of the pain, examination findings, the condition of the bile ducts and the individual's surgical risk are considered together. Jaundice, fever and severe pain that does not settle are reasons not to wait for a routine appointment.
What symptoms can gallstones cause?
The gallbladder is a small organ beneath the liver that stores bile. Bile is made in the liver and helps digest fats. Substances in bile can harden and form stones. When a stone blocks the flow of bile, pain develops in the upper right or upper middle part of the abdomen.
This pain sometimes spreads to the right shoulder blade or shoulder and is accompanied by nausea. It may start after a large meal, although not every attack has a clear link to food. Even if the pain settles after a while, you should tell the doctor about the attack. The pain stopping does not mean the stone has gone.
Bloating, a bitter taste in the mouth or heartburn alone do not prove that a gallstone is causing symptoms. These symptoms have other possible causes. Attributing every digestive symptom to an incidentally discovered stone may therefore mean that discomfort persists after surgery.
The initial assessment usually includes an abdominal ultrasound scan and blood tests that show how the liver is functioning. Ultrasound uses sound waves to create images of the organs. If a stone in a bile duct is still suspected, further imaging may be needed. The doctor will ask when the pain started, how long it lasted and whether it has happened before.
Choosing between observation and surgery
When observation is chosen for a stone that causes no symptoms, the patient needs to know which changes should prompt them to seek help. This does not mean having an ultrasound every month or taking preventive medication. Follow-up is tailored to other medical conditions and the findings of the assessment.
If there are attacks of pain consistent with gallstones, particularly if they recur, planned surgery is discussed. The operation removes not just the stones but the gallbladder in which they form. This procedure is called cholecystectomy. Removing the stones while leaving the gallbladder in place is not the usual treatment because stones can form again.
Medicines that dissolve stones are suitable only in certain circumstances, may take a long time to work, and do not prevent stones from forming again later. Changing the diet may help reduce some attacks, but it does not remove all existing stones. Trying to flush the gallbladder at home with mixtures such as oil and lemon can delay treatment.
A stone that has moved into a bile duct is a separate problem. Sometimes a flexible instrument passed through the mouth is needed to reach the bile duct and remove the stone. This procedure, called ERCP, does not replace gallbladder removal; its purpose is to unblock the bile duct. The order of the procedure and surgery is planned according to the patient's condition.
When is pain an emergency?
Sudden inflammation of the gallbladder is called acute cholecystitis. Pain in the upper right abdomen lasting for hours, tenderness, fever and nausea may indicate this condition. The diagnosis is confirmed through a medical examination, blood tests and imaging.
Severe abdominal pain that does not settle.
Pain accompanied by fever, chills or repeated vomiting.
Yellowing of the skin and the whites of the eyes.
Dark urine, pale stools and worsening general health.
These symptoms require urgent medical assessment. A stone can also cause an infection in the bile ducts or inflammation of the pancreas. In acute cholecystitis, early surgery is preferred for patients who are fit for an operation. Hospital treatment with fluids, pain relief and antibiotics when needed is planned alongside the surgical decision.
If the surgical risk is too high at that time, a temporary measure such as draining the inflamed gallbladder through a tube may be needed. This option is not suitable for every patient. Further treatment is reassessed once the condition has improved.
How is the gallbladder removed?
Most planned operations use a laparoscopic approach: a camera and instruments are inserted through small abdominal incisions under general anaesthesia. The gallbladder is removed after the blood vessel supplying it and the duct carrying bile from it have been safely separated. The procedure page provides further information about Laparoscopic Gallbladder Surgery.
A version using fine instruments can be seen in the Mini-laparoscopic cholecystectomy video. This surgical footage is intended for adults. Instrument size is only one part of an individual surgical plan.
Severe inflammation or difficulty seeing the course of the blood vessels and bile ducts clearly may require a change of plan, including conversion to open surgery. Possible complications include bleeding, infection, bile leakage and bile duct injury. The risks discussed by the surgeon should cover both the disease itself and the chosen procedure.
Eating and everyday life without a gallbladder
The liver continues to make bile after the operation. Bile flows into the bowel without first being stored in the gallbladder, and most people can return to their usual diet. Not everyone needs a lifelong fat-free diet. Small portions may be more comfortable in the first few days; very fatty foods that cause discomfort can be reduced.
Some people develop looser stools and need to open their bowels more often. If this persists or causes dehydration or weight loss, a doctor should assess it. There is no need to wait for months assuming that the symptom is an unavoidable consequence of living without a gallbladder.
Light activity is resumed gradually. Although returning to work is often possible within one or two weeks, heavy physical work and open surgery may require a longer recovery. If increasing pain, fever, jaundice or wound discharge develops after discharge from hospital, contact the surgical team promptly.