Gallstones are hardened deposits that form in the gallbladder, a small organ under the liver that stores bile. Many people have them without ever knowing. When they cause symptoms or complications, treatment is usually recommended.
What gallstones are
Bile is produced by the liver and concentrated in the gallbladder, which releases it into the intestine to help digest fat. When the balance of cholesterol, bile salts and pigments in bile shifts, crystals form and can grow into stones ranging from sand-like particles to several centimetres.
Problems arise not because the stone exists, but because it moves — obstructing the outlet of the gallbladder or passing into the bile duct.
Symptoms patients usually notice
- Biliary colic — steady, intense pain in the upper abdomen, often on the right or in the centre, frequently radiating to the back or right shoulder blade
- Pain that starts after eating, particularly a fatty meal, and often at night
- Nausea and vomiting with the pain
- Bloating, indigestion and fat intolerance, which are less specific
Classic biliary colic builds over minutes, lasts from thirty minutes to several hours, and then settles — unlike the constant pain of inflammation.
Signs of a complication
Seek urgent medical assessment if — the pain lasts more than a few hours or is accompanied by fever, or if the whites of the eyes or the skin turn yellow, the urine darkens or the stools become pale. These can indicate inflammation of the gallbladder, a stone in the bile duct, infection of the bile ducts, or pancreatitis — all of which need prompt assessment rather than an outpatient appointment.
How gallstones are assessed
An abdominal ultrasound is the usual first investigation and is good at detecting stones in the gallbladder. Blood tests including liver function and inflammatory markers help identify complications. Where a stone in the bile duct is suspected, further imaging such as MRCP, or a CT scan, may be used.
Assessment distinguishes between three situations, because they are managed differently: stones found incidentally with no symptoms; stones causing biliary colic; and stones that have already caused a complication.
Treatment options
Observation
Gallstones found incidentally, in someone who has never had symptoms, are commonly monitored rather than operated on. The majority of silent stones never cause trouble, and surgery carries its own risks. There are exceptions where surgery is considered even without symptoms, and those are individual decisions.
Cholecystectomy
The definitive treatment for symptomatic gallstones is removal of the gallbladder, most commonly performed as a minimally invasive (laparoscopic) operation through several small incisions. Removing the stones alone is not standard practice, because the gallbladder that produced them would simply produce more.
Living without a gallbladder is generally well tolerated. Bile flows continuously from the liver into the intestine instead of being stored and released in a bolus. Some people notice looser or more frequent stools, particularly in the first months.
Treating bile duct stones
If a stone has passed into the bile duct, it usually has to be dealt with separately — often endoscopically, before or around the time of gallbladder removal. This is part of why assessment looks at the bile duct and not only at the gallbladder.
When surgery may be considered
- Repeated episodes of biliary colic
- An episode of acute cholecystitis — inflammation of the gallbladder
- A stone that has caused jaundice, cholangitis or gallstone pancreatitis
- Symptoms significant enough to interfere with eating and daily life
Risks and considerations
- Bleeding and infection, as with any operation
- Bile leak from the area where the gallbladder was detached
- Injury to the bile duct — uncommon, but the most serious specific risk of this operation, which is why the anatomy is identified carefully before anything is divided
- Retained stone in the bile duct, which may need endoscopic treatment
- Conversion from a minimally invasive approach to an open operation, which is a judgement made for safety rather than a complication in itself
- Loose stools or fat intolerance afterwards, usually temporary
- The general risks of anaesthesia
Recovery and aftercare
Minimally invasive gallbladder removal is often a day-case or single-night-stay operation. Most people return to light activity within days and to fuller activity over a few weeks, with the pace depending on the individual and on whether the gallbladder was acutely inflamed.
Diet is usually returned to normal gradually rather than restricted permanently. Where loose stools occur they commonly settle over weeks to months. The specific plan comes from the operating team.
Frequently asked questions
Do gallstones always need surgery?
No. Stones found incidentally in someone with no symptoms are usually monitored. Surgery is generally recommended once stones cause symptoms or complications, because episodes tend to recur.
Can medication or diet dissolve gallstones?
Dissolution therapy exists but works only for certain stone types, takes a long time, and stones frequently return when it stops. It is not a general substitute for surgery in symptomatic disease. Reducing fat intake may reduce how often attacks are triggered but does not remove the stones.
Why remove the whole gallbladder rather than just the stones?
Because the gallbladder that formed the stones would continue to form them. Removing stones alone is associated with a high rate of recurrence.
What happens to digestion afterwards?
Most people digest normally. Bile flows continuously into the intestine instead of being stored. Some notice looser or more frequent stools, particularly early on, and this usually settles.
Is the pain of gallstones always on the right?
Not always. It is often felt in the upper right abdomen, but it may be central, and it commonly radiates to the back or right shoulder blade. Any severe or persistent upper abdominal pain should be assessed.