Gallstones: Should I Have Gallbladder Surgery?

Gallstones are stones made of cholesterol and other things found in bile. They form in the gallbladder or bile duct. They may be as small as a grain of sand or as large as a golf ball.

Most people with gallstones have no symptoms and don't need treatment. Those who do have symptoms often have surgery to remove the gallbladder.

In people who do have symptoms, the most common one is pain in the upper right area of your belly. Other symptoms include nausea and vomiting.

Symptoms usually don't come back after the gallbladder has been removed.

If gallstones block a duct, you may get jaundice. Jaundice makes your skin and the whites of your eyes yellow. It can also cause dark urine and light-colored stools.

Laparoscopic gallbladder surgery is the most common surgery done to remove the gallbladder. The doctor inserts a lighted viewing instrument called a laparoscope and surgical tools into your belly through several small cuts. This type of surgery is very safe. People who have it usually recover enough in 7 to 10 days to go back to work or to their normal routine.

Open gallbladder surgery involves taking the gallbladder out through one larger incision in your belly. Open surgery may be done if laparoscopic surgery is not an option or when problems are found during laparoscopic surgery. The hospital stay is longer with open surgery.

Stones in the bile duct

If gallstones are found in the common bile duct before or during surgery to remove the gallbladder, a doctor may do a procedure called an ERCP (endoscopic retrograde cholangiopancreatogram). This involves putting a tube called an endoscope down your throat to your small intestine. The doctor uses the scope to look for stones in the duct and remove them.

The overall risk from laparoscopic gallbladder surgery is very low. The most serious risks include:

• Infection.
• Bleeding.
• Injury to the common bile duct.
• Injury to the small intestine by one of the tools used during surgery.

Risks from open gallbladder surgery include:

• Injury to the common bile duct.
• Bleeding.
• Infection.
• Injuries to the liver, intestines, or major blood vessels in the belly.
• Blood clots or pneumonia related to the longer recovery period after open surgery.

Both surgeries have the risks of general anesthesia.

Postcholecystectomy syndrome

After gallbladder surgery (cholecystectomy), a few people have ongoing symptoms, such as belly pain, bloating, gas, or diarrhea. This is called postcholecystectomy syndrome. These symptoms can be treated with medicines.

There is little risk in not having surgery if you have only one mild attack. But if you have more than one painful attack, you're likely to have more in the future.

The risks of not treating gallstones may include:

• Unpredictable attacks of gallstone pain.
• Episodes of inflammation or serious infection of the gallbladder, bile ducts, or pancreas.
• Jaundice and other symptoms caused by blockage of the common bile duct. Jaundice makes your skin and the whites of your eyes yellow. It can also cause dark urine and light-colored stools.

About 1 out of 3 people with gallstones who have a single attack of pain or other symptoms do not have symptoms again.^{footnote 1} That means that 2 out of 3 people do have another attack.

You may be able to prevent gallstone attacks if you:

• Stay close to a healthy weight by eating a balanced diet and getting regular exercise.
• Avoid rapid weight loss. When you lose weight by dieting and then you gain weight back again, you increase your risk of gallstones, especially if you are a woman. If you need to lose weight, do it slowly and sensibly.

Your doctor may recommend surgery if:

• You have repeated gallstone attacks.
• The pain from the attacks is severe.
• You have complications, such as inflammation of the gallbladder or the pancreas.
• You have an impaired immune system.