Gallbladder Stones: Is Removal Necessary? Symptoms, Risks of Waiting and Cost Factors

Not always. Gallbladder stones that were found by chance and cause no symptoms can usually be watched rather than removed. Once stones start causing pain, or a complication such as inflammation, jaundice or pancreatitis, surgeons generally advise removing the gallbladder, usually by laparoscopic (keyhole) surgery. A few situations, such as a calcified gallbladder wall, may need surgery even without pain.

Dr Y Satish Reddy practises surgical gastroenterology at STAR Hospitals, Financial District, Hyderabad.

Many of my gallstone patients did not come to me because of pain. They came because a stone turned up on an ultrasound done for something else: a routine health check, a pregnancy scan, a liver test. Now they have a report with the word "cholelithiasis" on it and a phone full of worrying search results. So let me put things in order.

Key points

• Silent stones (no symptoms) usually do not need surgery; they are watched.
• Stones that have caused pain or a complication are usually removed at a planned time.
• Typical pain is in the upper right or middle of the tummy, often after a heavy meal, lasting more than 30 minutes.
• Yellow eyes or skin, high fever with shivering, or severe pain with vomiting need urgent care.
• Diets, herbal "flushes" and medicines do not reliably clear gallbladder stones.

What are gallbladder stones?

Gallbladder stones (gallstones) are hard lumps that form in the gallbladder, a small pouch under the liver that stores bile, the fluid your body uses to digest fat. When bile sits too long or its make-up changes, it can harden into stones. They range from fine sand to the size of a small lemon.

They are very common, and most people who have them never feel a thing. The NHS lists being over 40, being a woman, obesity, rapid weight loss and diabetes among the things that make them more likely.

Do gallbladder stones always need surgery?

No. The deciding question is whether the stones cause symptoms. Stones found by chance, in a gallbladder that otherwise looks normal, usually just need watching. Stones that have caused pain or a complication are a different matter, and planned removal of the gallbladder is usually advised.

This matches NICE guidance in the UK, which recommends a watch-and-wait approach for people without symptoms to avoid unnecessary surgery. The NHS gives the same advice. If you have silent stones, we may still see you for occasional follow-up so that any change is picked up.

What are the symptoms of gallbladder stones?

The classic symptom is a steady pain in the upper right or middle of the tummy, often after a heavy or oily meal, lasting from half an hour to a few hours. It may spread to the right shoulder blade or back and come with nausea or vomiting. This pain is called biliary colic.

• Pain under the right ribs or in the upper middle tummy, lasting more than 30 minutes
• Pain that spreads to the right shoulder blade or the back
• Nausea or vomiting with the pain
• Heaviness or bloating after meals that keeps being put down to gas or acidity

"That last point matters. In India, a lot of gallstone pain is treated as a 'gastric problem' for a year or more before anyone thinks of doing a scan." If acidity keeps coming back, our article on recurring acidity explains when to get it checked.

What are the risks of waiting once stones cause symptoms?

Once stones have caused pain, attacks often come back, even if they settle for a while. Occasionally a stone slips out and blocks a bile duct, which can inflame the gallbladder (cholecystitis) or pancreas (pancreatitis), or cause jaundice. These complications are uncommon, but they usually mean an emergency admission rather than a planned operation.

The NIDDK notes that gallstone symptoms may go away but can return. According to the NHS, complications are rare but include inflammation of the gallbladder or pancreas and jaundice. For people with an acutely inflamed gallbladder, NICE recommends surgery within one week.

Removing a settled gallbladder at a time we choose is a routine operation. Removing an inflamed one in an emergency is harder, and the hospital stay is usually longer. That is the real reason I advise planning surgery once there are symptoms.

When do you need urgent help for gallstone pain?

Go to the emergency department straight away if the pain is sudden and severe, spreads to the back with vomiting, or comes with high fever, shivering, or yellow skin or eyes. These can be signs that a stone is blocking a duct or the gallbladder is infected. Pain lasting more than 30 minutes also needs a same-day check.

These warning signs follow the NHS gallstones page.

Can gallbladder stones be treated without surgery?

Only in limited situations. Medicines that dissolve stones work only on small cholesterol stones, take months or years, and the stones often come back. Diets, herbal remedies and liver "flushes" do not remove gallbladder stones. That is why surgeons remove the whole gallbladder, not just the stones.

The NIDDK describes non-surgical treatments as options for special cases, such as people with cholesterol stones who cannot have surgery, and notes that stones can return. The lumps people pass after a so-called liver flush are usually soap-like balls formed from the oil they drank, not stones. Shockwave treatment, which works well for kidney stones, is rarely used for gallstones.

A gallbladder that has made stones once tends to make them again, so removing just the stones does not solve the problem.

When might surgery be advised even for silent stones?

A few findings can tip the balance towards surgery even without pain. Your surgeon will weigh these against your general health and explain the reasoning.

• Very large stones, roughly 3 cm or more
• Polyps in the gallbladder along with stones
• A calcified ("porcelain") gallbladder wall on the scan
• Planned weight-loss (bariatric) surgery, or certain blood disorders

What happens during gallbladder removal surgery?

The usual operation is a laparoscopic cholecystectomy: the gallbladder is removed through three or four small cuts using a camera. It typically takes about 45 minutes to an hour. Many planned cases are done as day-care or with a one-night stay, depending on how you recover.

For more difficult situations, such as a badly inflamed gallbladder or previous abdominal surgery, robotic assistance may be an option; see robotic surgery. Occasionally an open operation is needed, which means a longer stay. The NIDDK notes that after laparoscopic removal most people return to normal physical activity in about a week.

More detail on the procedure is on our gallbladder stone surgery page and our page on laparoscopic surgery.

What affects the cost of gallbladder stone surgery?

The cost depends mainly on whether surgery is planned or done as an emergency, the approach used (laparoscopic, robotic or open), the length of stay, the tests needed beforehand, the room category and your insurance cover. Emergency surgery for an inflamed gallbladder usually means a longer stay than a planned operation.

Because every case differs, ask the hospital's billing desk for a written estimate after your consultation, and check with your insurer what is covered.

Can you live normally without a gallbladder?

Yes. Your liver keeps making bile; it simply flows straight into the intestine instead of being stored first. A few people notice softer or more frequent stools for some weeks, and this usually settles. No lifelong special diet is needed.

The NIDDK describes the gallbladder as a non-essential organ. Our article on life after gallbladder removal covers diet and digestion in more detail.

The short version

Silent stones: usually we watch. Stones that have caused pain, even mild pain and even once, are worth discussing with a surgeon so that removal can be planned before it becomes an emergency. Consult a qualified doctor if symptoms persist.