Gallstones are found incidentally on a large number of abdominal ultrasounds, and the immediate question is always whether surgery is needed. In most cases it is not.
Around eighty percent of people with gallstones never develop symptoms. The decision depends on whether the stones are causing trouble, not on whether they exist.
How Gallstones Form
The gallbladder stores bile, a fluid made by the liver that helps digest fat. When the balance of cholesterol, bile salts and pigments in bile shifts, crystals form and grow into stones.
Most stones in India are cholesterol stones. Pigment stones occur in conditions where red cells break down excessively, such as haemolytic anaemias.
Risk factors include being female, increasing age, pregnancy, obesity, rapid weight loss, diabetes, a high refined carbohydrate diet and a family history.
Rapid weight loss deserves specific mention, since crash dieting and bariatric surgery both increase stone formation considerably.
What Biliary Colic Feels Like
The characteristic pain occurs when a stone temporarily blocks the gallbladder outlet.
- Severe pain in the upper right abdomen or just below the breastbone
- Often radiating to the right shoulder blade or back
- Typically starting thirty minutes to an hour after a fatty meal
- Lasting from thirty minutes to several hours
- Constant and building rather than coming in waves, despite the name colic
- Often with nausea and vomiting
- Settling completely between episodes
Pain at night waking the patient is common. Vague indigestion, bloating and belching are frequently blamed on gallstones but are often unrelated, and removing the gallbladder does not reliably relieve them.
The Complications That Change Everything
These are the reasons surgery is recommended once stones become symptomatic.
- Acute cholecystitis: the gallbladder becomes inflamed and infected, with pain lasting beyond six hours, fever and tenderness
- Choledocholithiasis: a stone passing into the bile duct, causing jaundice, dark urine and pale stools
- Cholangitis: infection of the blocked bile duct, with fever, jaundice and pain. A medical emergency
- Gallstone pancreatitis: a stone blocking the pancreatic duct, causing severe pain and a potentially serious illness
- Gallbladder perforation, which is uncommon and serious
Pancreatitis is the complication that most changes the calculation. Once it has occurred, gallbladder removal is strongly recommended, ideally during the same admission or soon after, because recurrence risk is high.
Who Does Not Need Surgery
Silent gallstones found incidentally, with no symptoms ever, are generally left alone. The risk of developing symptoms is low each year, and the risk of surgery is not zero.
There are exceptions where removal is advised even without symptoms.
- A calcified or porcelain gallbladder, which carries cancer risk
- Very large stones, generally over three centimetres
- Gallbladder polyps above a certain size alongside stones
- Certain haemolytic conditions
- Patients about to undergo other major abdominal surgery, in some situations
Once you have had one episode of biliary colic, further episodes are likely, and surgery is usually recommended rather than waiting for a complication.
The Operation
Laparoscopic cholecystectomy removes the whole gallbladder through several small incisions.
A camera and instruments are inserted, the abdomen is inflated with gas to create space, the artery and duct to the gallbladder are clipped and divided, and the gallbladder is removed through one of the small openings.
It takes around an hour under general anaesthetic. Most patients go home the same day or the next morning. A small proportion require conversion to open surgery, usually because of severe inflammation or unclear anatomy, and this is a safety decision rather than a complication.
Our laparoscopic surgery department performs these routinely, and Dr. Pinak Dasgupta sees gallbladder referrals.
Life Without a Gallbladder
The gallbladder stores and concentrates bile, it does not produce it. After removal, the liver continues making bile which flows continuously into the intestine rather than being released in a concentrated pulse.
Most people notice no difference and eat normally within weeks. Some experience looser stools or urgency after fatty meals for a few months, which usually settles as the bile ducts adapt.
- Reintroduce fatty foods gradually over the first few weeks
- Smaller more frequent meals initially
- Most patients return to a completely normal diet
- Persistent diarrhoea may indicate bile acid malabsorption, which is treatable
Persistent diarrhoea after gallbladder removal is common enough to be worth mentioning to your doctor rather than enduring, since a simple medication resolves it.
Recovery After Surgery
Laparoscopic recovery is considerably faster than open surgery.
- Day of surgery: walking within a few hours, eating light food
- Days 1 to 3: some shoulder tip pain from residual gas, which is expected and settles
- Week 1: light activity, no lifting over five kilograms
- Weeks 2 to 3: return to desk work
- Weeks 4 to 6: full activity including exercise and heavy work
Shoulder pain after laparoscopic surgery surprises patients. It comes from gas irritating the diaphragm and is not a complication. Walking helps it disperse.
Contact your surgeon for fever, increasing abdominal pain, jaundice, persistent vomiting, or wound redness and discharge.
Can Diet or Medicine Dissolve Them?
Patients frequently ask about avoiding surgery. The honest answer is that alternatives are limited.
Bile acid tablets can dissolve small cholesterol stones over one to two years, but they work only for a minority of patients with specific stone characteristics, and stones commonly recur when treatment stops.
Shock wave lithotripsy is rarely used for gallstones because fragments still cause problems and the gallbladder remains diseased.
There is no dietary regimen or home remedy that dissolves gallstones. Reducing fatty food may reduce how often you get pain, but the stones remain. Avoiding fat also does not prevent complications.
Silent gallstones can usually be left alone. Once they cause pain, surgery is generally the right answer, because episodes recur and complications become more likely. Laparoscopic removal is a day case procedure for most patients with a fast return to normal life.
Our general surgery and gastroenterology departments at T. Nagar assess gallstone disease.
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