Gallstone removal is a treatment indicated for symptomatic gallstones. Removal of gallstones, or choleliths can be done by non-surgical or surgical methods. In most cases, cholecystectomy — the removal of the gallbladder — is done to treat recurrent gallstones.
What are gallstones?
The gallbladder is a pouch-like organ next to your liver and stomach which functions to store bile. Bile is a type of digestive fluid produced by your liver to digest fats in your food. Gallstones can form in your gallbladder from crystalline deposits of cholesterol, bilirubin, and bile. Gallstones are mainly grouped into 2 types:
Cholesterol stones – Cholesterol stones are composed mainly of cholesterol (>70%), and are more common.
Pigment stones – Pigment stones are darker in colour due to the presence of bilirubin, and have a lower content of cholesterol (<30%).
Other types of stones have also been reported, such as calcium carbonate stones, phosphate stones, and mixed stones [1]. Gallstones often occur when the bile is unable to dissolve excess material, leading to the formation of small crystals in the gallbladder. These crystals can coalesce and become large. Migration of larger gallstones can cause obstruction of the bile duct. These obstructions can cause pain, cholangitis, or pancreatitis [2].
In some cases, gallstones may not cause any symptoms or pain, and can be left untreated. These are typically called “silent” gallstones. Common signs of a symptomatic gallstone are:
Sudden, intense pain in your upper right abdomen
Sudden, intense pain in the centre of your abdomen, below the breastbone
Pain on your back or shoulder blades
Pain in the right shoulder
Nausea and vomiting
Fever and chills
Jaundice
If left untreated, symptomatic gallstones can lead to other more serious complications such as cholecystitis (inflammation of the gallbladder), pancreatitis (inflammation of the pancreas), infections and sepsis [2].
Do all gallstones need to be removed?
No, not all gallstones need to be removed. However, they do require treatment if you experience the following:
Pain (biliary colic), especially after eating
Symptoms of inflammation, such as fever, nausea or abdominal pain
If the stones block the bile duct, which can lead to jaundice or pancreatitis
If you experience recurrent gallstone attacks
If you experience the following, it’s important to see a doctor immediately, as these could be signs of gallstone complications.
Gallstones are formed from the crystals formed in bile, which slowly grow bigger, and can potentially get lodged in the bile duct.
How are gallstones removed?
Although asymptomatic gallbladders can be left alone, biliary obstruction caused by gallstones require treatment to relieve the symptoms and prevent serious complications.
Non-surgical treatment
Oral medication – Doctors may prescribe medications that can dissolve the bile stones, common types of medications for gallstone dissolution include ursodiol and chenodiol. Other types of medications may be given, primarily to mitigate gallstone formation, these may include statins and ezetimibe, which are drugs used to treat hypercholesterolaemia. Medical treatment is however not the first line of treatment for gallstones. Medical therapy is usually reserved for individuals with high surgical risk.
Endoscopic retrograde cholangiopancreatography (ERCP) – ERCP involves using an endoscope, which is inserted through the upper digestive tract, along with x-ray to observe the gallstones in the gallbladder or bile duct. While doctors typically use ERCP to diagnose or locate gallstones, it can also be used to remove gallstones and bile duct obstructions.
Surgical treatment
Sphincterotomy – Sphincterotomy for gallstone removal is usually done with ERCP. The procedure involves making incisions on the sphincter of Oddi, the sphincter muscles of the opening of the bile duct. This allows the gallstones to pass through more easily, improves gallbladder emptying, and reduces formation of gallstones [3].
Cholecystectomy – Cholecystectomy is the removal of the gallbladder, and is the most common treatment for symptomatic gallstones. You can live without a gallbladder, the bile produced by the liver is then channeled directly to the small intestine instead of being stored. However, some patients may experience post-cholecystectomy syndrome after the surgery, with symptoms such as diarrhoea, abdominal pain, indigestion, and jaundice. These symptoms resolve in 95% of patients after the first month
The surgical procedures can be an open surgery or a laparoscopic surgery. A laparoscopic cholecystectomy is mostly preferred as it is less invasive than an open surgery. Cholecystectomy also prevents recurrences of gallstones.
What are the risks associated with gallstone removal procedures?
Risks are common in surgical procedures, common risks or complications associated with gallbladder removal include:
Bleeding – Bleeding is a common risk associated with surgical procedures, as blood vessels can be affected during the procedure.
Infections – Infections are also another common complication in surgery, often as a result of improper care of the surgical wound during recovery.
Damage to nearby organs – Risk of damage to nearby organs such as the stomach, intestines, or the bile duct is present with surgical removal of gallstones, or with cholecystectomy. Injury to the bile or hepatic duct may require further surgical management to redirect the flow of bile from the liver to the small intestines.
Scarring – Open surgeries often leave large incision scars. Minimally invasive procedures can reduce this risk.
Bile leakage – Bile leakage can occur in cholecystectomy procedures, where the bile flows out to the abdomen, causing abdominal pain, fever, and swelling around the abdomen.
What can I expect during a gallstone removal procedure?
Before your gallstone removal treatment, you will need to be diagnosed for gallstones. The process of gallstone removal is typically as follows:
Consultation
Your doctor will perform several tests to diagnose you for gallstones or gallbladder diseases before recommending you for a gallstone removal procedure.
Ultrasound imaging – Your doctor will perform an abdominal ultrasound to look for gallstones. Ultrasounds are relatively cheap and accessible, hence why they are commonly used in gallstone diagnosis.
Other imaging tests – Your doctor may also perform other types of imaging tests if more information cannot be obtained from ultrasound imaging, these tests may include computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, or ERCP.
Blood tests – Your doctor may also order some blood tests to be performed to look for signs of infection or pancreatitis which may result from the bile duct obstruction.
Gallstone removal
Once your doctor completes your diagnosis, they will recommend the most suitable gallstone removal treatment for you. Before you go in for your procedure, your doctor will discuss the type of procedure and what it entails, as well as possible risks and recovery expectations.
Preparation – Before your surgery, your doctor may tell you to stop taking certain types of medicine, or to fast from the night before. Take plenty of rest before the day of the surgery.
Removal procedure – Gallstone removal procedures are typically done under general anaesthesia, where you will be in an unconscious or a sleep-like state. Your doctor will then perform the indicated treatment, such as laparoscopic or open cholecystectomy.
Recovery
Most patients who underwent a laparoscopic cholecystectomy go home after the surgery, or require a day’s stay at the hospital. Open cholecystectomies are more complicated, hence patients may be required to stay for a longer period of time, up to a week. Once discharged, your healthcare team will give you post-operative care instructions.
Wound care – You should keep the incision wound clean and dry, and change the bandages if they get wet. This is important to prevent the risk of infecting the incision wound.
Pain management – Your doctor may prescribe pain medication to alleviate pain and inflammation associated with the surgery. It is important to follow your doctor’s recommended dosage to prevent side effects of your pain medication.
Dietary adjustments – During your recovery period, your doctor may recommend some dietary changes such as eating less fatty or greasy foods as this can increase bile production.
Follow-up – Your doctor may also ask you to come in for a follow-up appointment 2 to 3 weeks after the procedure to ensure that you are recovering properly from the surgery, or to assess risks and complications post-surgery.
Recovery from gallstone removal treatments may be different for everyone, it is important to take note of any abnormal changes, such as signs of infection, and seek immediate medical attention. Most patients fully recover from their procedure within a month.
Summary
Gallstone removal procedures are mostly indicated for symptomatic gallstones that cause pain and discomfort. If you were diagnosed with silent or asymptomatic gallstones, you have the option to leave them untreated or prevent their growth. Bile duct obstruction caused by gallstones can lead to serious complications if left untreated.
If you experience constant and progressive pain caused by gallstones, it is highly recommended to seek medical attention immediately. Book a consultation with us for a detailed diagnosis and personalised treatment plan.
Frequently Asked Questions
Can gallstones be removed without surgery?
Non-surgical treatment of gallstones are available, such as the use of medication to dissolve the gallstones. However, larger stones may need to be surgically removed, especially if they cause intense pain, or obstruct the bile duct.
Will gallstones go away on their own?
Gallstones will not typically go away on their own. You can take medication to dissolve them, but complete removal is unlikely. Furthermore, more gallstones may also grow.
Will gallstones come back after a gallbladder removal?
Typically, gallstones do not come back after a cholecystectomy. However, in rare occasions, crystallised bile can also form in the bile duct, this is known as choledocholithiasis.
References
Qiao T, Ma RH, Luo XB, Yang LQ, Luo ZL, Zheng PM. The systematic classification of gallbladder stones. PLoS One. 2013 Oct 4;8(10):e74887. doi: 10.1371/journal.pone.0074887. PMID: 24124459; PMCID: PMC3790764.
Jones MW, Weir CB, Ghassemzadeh S. Gallstones (Cholelithiasis) [Updated 2024 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459370/
Zhang C, Yang YL, Ma YF, Zhang HW, Shi LJ, Li JY, Lin MJ, Qi CC. Endoscopic Sphincterotomy for Gallbladder Muddy Stones or Sludge in Patients With Papillary Disease: A Retrospective Study. Surg Laparosc Endosc Percutan Tech. 2018 Feb;28(1):30-35. doi: 10.1097/SLE.0000000000000382. PMID: 28277438.
Zha Y, Zhou ZZ, Chen XR, Gan P, Tan J. Gallbladder-preserving cholelithotomy in laparoscopic and flexible choledochoscopic era: a report of 316 cases. Surg Laparosc Endosc Percutan Tech. 2013 Apr;23(2):167-70. doi: 10.1097/SLE.0b013e31828a0b5f. PMID: 23579512.
