Gallstones – how are they treated?

In this article, Mr Satya Bhattacharya, Consultant General and Hepatobiliary Surgeon, explains more about gallstones, the symptoms they can cause, how they are managed, and the surgical techniques used to remove the gallbladder.

Gallstones are very common. Around 10% of all adults have gallstones and the condition becomes more likely over the age of 40. But only a small proportion of people whose gallbladder contains gallstones experience problems. The most common sign that gallstones are becoming troublesome is biliary colic – pain in the upper right of the abdomen. Once any sort of symptoms develop, surgery to remove the gallbladder is the only effective treatment.

In the UK around 4.5 million people have gallstones at any one time and 50,000 of them need to have their gallbladder removed each year.

What are gallstones?

Gallstones are hard particles that form in the gallbladder. This is a small pouch that sits under the liver and that functions as a storage bag for bile. Bile is made in the liver , stored in the gallbladder and passes into the small intestine through the bile duct. The fluid, which is green and bitter tasting, contains emulsifiers that helps break down fats so they can be more easily digested.

It is common for some of the compounds in bile to become solid and hard. These particles are tiny at first, but they can then attract other particles and grow. Someone with gallstones may have just one large stone, or many smaller ones. The stones themselves contain cholesterol or calcium or bile pigments, or a mixture of two or three different compounds.

What affects your risk of developing gallstones?

Some factors that increase risk include:

  • A family history of gallstones
  • Being over 40
  • Being female
  • Having multiple pregnancies
  • Having diabetes (type 1 or type 2)
  • Losing a lot of weight quickly

Factors that make it less likely that gallstones will develop include:

  • Being male
  • Drinking alcohol in moderation
  • Eating a diet high in plant fibre (vegetarians tend to be less prone to gallstones)

What symptoms can gallstones cause?

Many people with gallstones will have mild or infrequent attacks of biliary colic. This is the medical term used to describe the sharp pain in the upper right of the abdomen that occurs when the gall bladder tries to push a gallstone into the bile duct. As the gall bladder squeezes hard, this causes pain. If the gallstone is squeezed out into the bile duct and then into the intestine, or falls backwards into the gallbladder, the pain subsides.

This can happen once in a while, or it can happen every so often causing the same type of niggling pain. Attacks of biliary colic can last minutes or a few hours.

More severe symptoms:

  • Jaundice: your skin and the whites of your eyes turn yellow. This is because a small stone has become lodged in the bile duct, blocking the flow of bile. The pigments in the bile get into the blood, causing the colour change in your skin and eyes. An operation may be needed to remove the gallstone if it does not pass out of the bile duct.
  • Pain in the central upper abdomen: the pancreas and gallbladder both have ducts that empty into the intestine through a common opening. If a gallstone from the gallbladder gets stuck at this point, it can block the exit of digestive enzymes from the pancreas, which can cause the pancreas to become inflamed. Pancreatitis is a medical emergency that often needs hospital treatment and surgery to remove the gallstones.
  • Intense pain in the upper right of the abdomen, fever, nausea, vomiting. This lasts more than a few hours and indicates that the gallstones have irritated the wall of the gallbladder, causing it to become inflamed. Cholecystitis, or inflammation of the gallbladder, can lead to infection, so this is a medical emergency. The gallbladder then needs to be removed, ideally as soon as possible.

Infection in the bile duct can also occur and can cause a mixture of all of these severe symptoms. A bile duct infection is called cholangitis and is relatively rare, but can be a serious life-threatening problem.

When gallstones cause no symptoms

Many people have gallstones but do not realise this, as they have no symptoms. The presence of stones can be detected during a diagnostic investigation for another medical problem. They show up very well on ultrasound scans, so if you are having one of these, you may find out that your gallbladder contains stones. There is nothing to worry about as long as you have no symptoms. Even though gallbladder removal is a fairly routine operation that is successful in the vast majority of patients, every operation carries some risks. There is no point in having surgery that you do not need.

When gallstones cause symptoms

If you suffer occasional bouts of biliary colic that do not last long, you may find you can cope with them easily and reduce the frequency of the attacks by adopting a low-fat diet. But at this stage you do need to discuss with your doctor if you need tests to exclude other causes of upper abdominal pain.

Once gallstones begin to cause pain, the pain often keeps recurring and it gradually gets worse. Unfortunately, there are no effective drug treatments to dissolve gallstones and using ultrasound to break up the stones does not work very well in the gallbladder (lithotripsy is used successfully for kidney stones).

So, once you experience any symptoms, even mild attacks of biliary colic, surgical removal of the gall bladder is the only effective treatment. The only difference between patients who have mild or severe symptoms is the urgency with which the surgery needs to be arranged. If your symptoms become severe and you develop cholecystitis, pancreatitis or an infected bile duct, you may need emergency surgery to remove the gallbladder and any stones blocking the bile duct.

Types of surgery available

  • Laparoscopic cholecystectomy: this is a minimally invasive technique in which a specialised surgeon removes the gallbladder and the gallstones it contains by making 3-4 small incisions in the abdomen. The instruments and a laparoscope are inserted through these ports, allowing the surgeon to see the inside of the body on a large screen in the operating theatre. The surgical instruments are manipulated from outside the body and the gallbladder is removed. Because only small incisions are used, recovery after a laparoscopic cholecystectomy is much faster than after open surgery and you can be out of hospital in a day, and back to work in 1-2 weeks (depending on the nature of your work).
  • Open cholecystectomy: some patients are unable to have laparoscopic surgery – patients with a gallbladder that is very inflamed or scarred, for example. This decision will be taken by your surgical team after assessing all of your risk factors.
  • Relieving a bile duct blockage: this is usually done with an endoscopic retrograde cholangiopancreaotography (ERCP). An endoscope is introduced through the mouth, stomach and into the small intestine and the surgeon works directly within the bile duct. But stones in the gall bladder cannot be removed by this method.

Risks of gallbladder surgery

  • Risks associated with any surgery, having a general anaesthetic and being immobile in hospital (heart problems, deep vein thrombosis, pneumonia, excessive bleeding).
  • Damage to the intestine or liver during surgery.
  • The bile duct may be injured. This now occurs in fewer than 3 cases in every 1000, but it is a serious complication that can lead to bile leaking into the abdominal cavity. Another operation is required to repair the damage.
  • A gallstone can dislodge and fall into the bile duct, unnoticed by the surgeon. This may block the bile duct and cause jaundice and other symptoms. An ERCP will then be necessary.







The part of the body that contains the stomach, intestines, liver, gallbladder and other organs. Full medical glossary
Relating to the abdomen, which is the region of the body between the chest and the pelvis. Full medical glossary
The part of the body that contains the stomach, intestines, liver, gallbladder and other organs. Full medical glossary
A medication that reduces sensation. Full medical glossary
A fluid produced by the liver, which helps the fat ingested in food to combine with the digestive juices in the gut. Full medical glossary
Severe pain in the upper right-hand side of the abdomen usually caused by gallstones. Full medical glossary
The organ that stores urine. Full medical glossary
A fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. Full medical glossary
An element that forms the structure of bones and teeth and is essential to many of the body's functions. Full medical glossary
Inflammation of the bile duct. Full medical glossary
The surgical removal of the gallbladder. Full medical glossary
Acute or chronic inflammation of the gallbladder causing severe abdominal pain. Full medical glossary
A substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy. Full medical glossary
A severe spasmodic pain that occurs in waves of increasing intensity. Full medical glossary
A condition that is linked to, or is a consequence of, another disease or procedure. Full medical glossary
A fluid-filled, enclosed pouch developing in a bodily structure as part of a disease process Full medical glossary
Inflammation of the bladder. Full medical glossary
Obstruction of one of the deep veins, often in the calf, by a blood clot. Often abbreviated to DVT. Full medical glossary
A disorder caused by insufficient or absent production of the hormone insulin by the pancreas, or because the tissues are resistant to the effects. Full medical glossary
A tube-like viewing instrument that is inserted into a body cavity to investigate or treat disorders. Full medical glossary
A protein that speeds up chemical reactions in the body without being used up itself. Full medical glossary
An abbreviation for endoscopic retrograde cholangiopancreaticogram. Full medical glossary
One of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body. Full medical glossary
The raising of the body temperature above norma, which may be accompanied by symptoms such as shivering, headache and sweating. Full medical glossary
A viral infection affecting the respiratory system. Full medical glossary
Small pear-shaped organ that sits under the liver and that stores bile. Full medical glossary
Lumps of solid matter found in the gallbladder. Full medical glossary
The basic unit of genetic material carried on chromosomes. Full medical glossary
Invasion by organisms that may be harmful, for example bacteria or parasites. Full medical glossary
The body’s response to injury. Full medical glossary
The section of gut, or gastrointestinal tract, from the stomach to the anus. Full medical glossary
A term used to describe a yellow tinge to the skin and a yellowing of the whites of the eyes. It is caused by a build up of bilirubin in the blood. Full medical glossary
One of two bean-shaped organs that are located on either side of the body, below the ribcage. The main role of the kidneys is to filter out waste products from the blood. Full medical glossary
An instrument with attached light source, usually connected to a camera, which allows the examination of the organs during keyhole surgery. Full medical glossary
A keyhole surgical procedure. Full medical glossary
A large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats. Full medical glossary
A gland behind the stomach that produces digestive enzymes and the hormones insulin and glucagon, which together regulate glucose levels in the blood. Full medical glossary
A glandular organ that secretes digestive enzymes and hormones. Full medical glossary
Inflammation of the pancreas, a gland behind the stomach that produces digestive enzymes and the hormones insulin and glucagon. Full medical glossary
Inflammation of one or both lungs. Full medical glossary
Lying face-downwards. Full medical glossary
A pale yellow or green,creamy fluid found at the site of bacterial infection. Full medical glossary
the organ or the body where food is stored and broken down Full medical glossary
The formation of a blood clot. Full medical glossary
A diagnostic method in which very high frequency sound waves are passed into the body and the reflective echoes analysed to build a picture of the internal organs – or of the foetus in the uterus. Full medical glossary
A blood vessel that carries blood towards the heart. Full medical glossary
Expusion of the contents of the stomach through the mouth. Full medical glossary