Gallstone Treatment
Management of gallstones and related gallbladder problems, including surgery when indicated
What is gallstone treatment?
Bile is made continuously by the liver and parked in the gallbladder between meals, where it is concentrated several times over. Concentrating it is what makes it useful and also what makes it precipitate.
When the balance of cholesterol, bile salts and pigment tips, crystals form in the stored bile and grow slowly into stones. Being female, having had children, carrying extra weight, losing weight rapidly and a family history all push that balance the wrong way. A great many people carry stones and never know it.
Trouble begins mechanically. As the gallbladder squeezes after a fatty meal it can drive a stone into its own narrow neck, so the sac contracts against a blocked exit. Once a stone has managed that once it tends to do it again, and the first episode changes the advice for that reason.
What you might notice
- Stools gone pale with urine gone dark
- Pain in the upper right abdomen
- Upper abdominal pain going through to the back
- Yellow eyes or skin alongside the pain
- Yellowing of the eyes or skin
- Bloating after meals
- Nausea
How it is diagnosed
An ultrasound of the upper abdomen settles it. Stones cast a clear shadow, and the same scan measures the thickness of the gallbladder wall, which tells you whether there has been inflammation, and the width of the bile duct, which tells you whether anything has escaped downstream.
Liver blood tests are taken alongside. A rise in them shifts attention from the sac to the duct, and changes the order in which things are done.
An MRI of the ducts, which needs no dye and no instrument, is added when the blood tests and the ultrasound disagree, or when the duct looks wide but no stone can be seen in it.
Recovery
After a keyhole removal you eat the same evening, go home the next day, and most people are back to desk work within a week. The shoulder tip ache from the gas used to inflate the abdomen is normal and passes in a day or two.
Life without a gallbladder is essentially unchanged. Bile simply drips into the intestine continuously instead of arriving in a bolus, and a minority notice looser stools after very fatty meals for a few months while the duct adapts.
An open operation takes longer to get over. The wound below the ribs is sore on coughing and deep breathing for two to three weeks, the stay is three to five days, and heavy lifting waits six weeks.
If it is left untreated
Stones found by chance in someone who has never had an episode are usually left alone and kept under review. That is standard practice and not a compromise.
Once they have caused an attack the picture changes. Repeated blockage inflames and thickens the wall and can turn into an infection of the trapped bile. A stone that escapes into the bile duct blocks the drainage of the liver and yellows the skin, and one that lodges where the pancreatic duct joins sets off an inflammation of the pancreas that is serious and occasionally life-threatening.
Decades of stones abrading the wall are also associated with cancer of the gallbladder, which is uncommon but is one reason a thickened or calcified wall on the scan is acted on without waiting for symptoms.
Questions about gallstone treatment
Can I dissolve gallstones with medication or diet?
In practice, no. Bile salt tablets work only on small cholesterol stones in a gallbladder that still empties well, take a year or more, and the stones return in most people once the tablets stop, so they are reserved for those who cannot have surgery. No diet dissolves a stone. Cutting fat can reduce how often the gallbladder is triggered into squeezing, which may reduce attacks, and it leaves the stones exactly where they are.
Do I need surgery if the stones are not troubling me?
Usually not. Stones found by chance, in someone who has never had an attack, are normally watched. Removal is advised without waiting when the gallbladder wall has become thickened or calcified, when there are very large stones or a polyp, and in some people with diabetes or a raised risk of gallbladder cancer. Once you have had one genuine attack, though, removal is usually recommended, because attacks tend to repeat.
Can I live normally without a gallbladder?
Yes. The gallbladder stores and concentrates bile; it does not make it. Once it is gone the liver's bile drips steadily into the intestine instead, and digestion carries on. Around one person in ten notices looser stools with very fatty meals for a few months afterwards, and that usually settles as the bile duct adapts. There is no special long-term diet to follow.
Other general surgery treatments
Treatment of abdominal wall hernias that cause pain, swelling or functional discomfort
Day CareAssessment and treatment of inflammation of the appendix, with surgery considered when clinically required
InpatientTalk to a care coordinator about gallstone treatment
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one