Medically reviewed by Prof. Dr. Zahid Mahmood, MBBS, FCPS — General, Laparoscopic & Laser Surgeon, Lahore.
Gallstones are hard deposits that form inside the gallbladder. Many people have them without ever knowing, but a stone that blocks the flow of bile can cause severe pain, inflammation, jaundice, infection or pancreatitis. The good news is that gallstones can usually be diagnosed easily, and symptomatic stones can be treated effectively with laparoscopic (keyhole) gallbladder surgery.
This guide explains the symptoms, causes, tests, treatment, recovery and prevention of gallstones in clear language.
What is the gallbladder?
The gallbladder is a small, pear-shaped organ beneath the liver. The liver continuously makes bile, a fluid that helps the body digest fat. The gallbladder stores and concentrates bile between meals, then releases it into the small intestine when needed.
The gallbladder is useful but not essential. After it is removed, the liver continues making bile and most people eat and live normally.
What are gallstones?
Gallstones, medically called cholelithiasis, form when substances in bile crystallise and gradually grow into solid deposits. A person may have one stone or many stones, and their size can vary considerably. The size or number of stones does not reliably predict symptoms; even a small stone can move into a bile duct and cause a serious complication.
More than 80% of people with gallstones have no symptoms. These “silent” stones are often discovered accidentally during an ultrasound performed for another reason.
Types of gallstones
- Cholesterol and mixed stones: These form when bile becomes oversaturated with cholesterol. They are the commonest types in many Western populations.
- Black pigment stones: These are associated with increased breakdown of red blood cells, certain inherited blood disorders, cirrhosis and increasing age.
- Brown pigment stones: These occur more often in the bile ducts and are linked with bile stasis and infection. Pigment stones are relatively more common in parts of Asia.
Why do gallstones form?
Gallstones develop when bile contains more cholesterol or pigment than it can keep dissolved, or when the gallbladder does not empty properly. Crystals then form, remain in stagnant bile and gradually enlarge.
Factors associated with gallstones include:
- Increasing age
- Female sex and pregnancy
- Overweight or obesity
- Rapid weight loss or crash dieting
- Family history and genetic factors
- Diabetes and metabolic disease
- Certain medicines, including oestrogen-containing treatment
- Ileal disease or previous ileal surgery
- Cirrhosis or chronic haemolytic blood disorders
- Bile-duct infection or obstruction
Having one or more risk factors does not mean that a person will definitely develop gallstones.
Symptoms of gallstones
The typical symptom is biliary pain, often called biliary colic. Despite the name, the pain is usually steady and severe rather than coming in waves.
Typical features include:
- Pain in the upper-right or upper-middle abdomen
- Pain that may spread to the back or right shoulder
- An attack lasting from several minutes to a few hours
- Attacks that often occur at night and may follow a heavy or fatty meal
- Nausea or vomiting
- Complete or near-complete relief between attacks
Bloating, belching, indigestion and intolerance of fatty food are common complaints, but they are not specific to gallstones. Other stomach, bowel, liver, pancreatic and even heart conditions can produce similar symptoms, so proper assessment is important.
When are gallstones an emergency?
Seek urgent medical care if you have:
- Severe or persistent upper-abdominal pain, especially with marked tenderness
- Fever or chills with abdominal pain
- Yellow eyes or skin, dark urine or pale stools
- Repeated vomiting or inability to keep fluids down
- Severe pain spreading through to the back
- Confusion, faintness, breathing difficulty or feeling seriously unwell
These symptoms may indicate acute cholecystitis, bile-duct obstruction, cholangitis or pancreatitis and should not be managed at home.
Complications of gallstones
- Acute cholecystitis: persistent blockage causes inflammation of the gallbladder, usually producing constant pain, tenderness and fever.
- Empyema, gangrene or perforation: a severely inflamed gallbladder may fill with pus, lose its blood supply or leak into the abdomen.
- Common bile-duct stones: a stone may leave the gallbladder and block the main bile duct, causing jaundice.
- Acute cholangitis: infection in an obstructed bile duct can spread rapidly and requires urgent hospital treatment.
- Acute pancreatitis: a migrating stone can block the shared outlet of the bile and pancreatic ducts and inflame the pancreas.
- Gallstone ileus: rarely, a large stone enters the intestine and causes bowel obstruction.
How are gallstones diagnosed?
Your doctor will assess the pain pattern, examine your abdomen and look for signs of inflammation or jaundice. Tests may include:
- Abdominal ultrasound: the first-choice scan for detecting gallbladder stones and signs of acute cholecystitis.
- Blood tests: a full blood count and inflammatory markers can suggest infection; liver tests can suggest bile-duct obstruction; pancreatic enzymes may be checked if pancreatitis is suspected.
- MRCP: a special MRI scan used when a stone in the common bile duct is suspected.
- CT scan: useful when the diagnosis is uncertain or a complication such as perforation or pancreatitis is suspected.
- ERCP: an endoscopic procedure mainly used to treat and remove confirmed or strongly suspected bile-duct stones.
Do silent gallstones need treatment?
Gallstones found by chance usually do not need treatment if they have never caused symptoms. Surgery may still be considered in selected higher-risk situations, including some very large stones, certain gallbladder polyps, a calcified gallbladder, common bile-duct stones, chronic haemolytic disorders or concern about malignancy. The decision should be individualised by a surgeon.
Treatment of symptomatic gallstones
Once gallstones cause typical pain or a complication, the definitive treatment is usually removal of the gallbladder, called cholecystectomy. Removing only the stones is not a reliable cure because stones tend to form again if the gallbladder remains.
Pain relief, intravenous fluids and anti-sickness treatment may be needed during an acute attack. Antibiotics are used when infection or acute cholecystitis is suspected; they are not a permanent treatment for gallstones.
If a stone is present in the common bile duct, it may be removed by ERCP before or around the time of gallbladder surgery.
Laparoscopic gallbladder surgery
Laparoscopic cholecystectomy is the procedure of choice for most patients. It is performed under general anaesthesia through a few small incisions using a camera and fine instruments. The surgeon carefully identifies the cystic duct and artery before removing the gallbladder.
Compared with open surgery, the keyhole approach usually causes less pain, leaves smaller scars, shortens the hospital stay and allows a faster return to normal activity. Many elective patients can go home the same day or the following day.
Occasionally, severe inflammation, scarring or unclear anatomy makes it safer to perform an open operation or a limited “bailout” procedure. Choosing the safer approach is sound surgical judgement, not a failure.
Is gallbladder surgery safe?
Laparoscopic cholecystectomy is a common and generally safe operation, but no surgery is risk-free. Possible complications include bleeding, wound infection, bile leakage, retained bile-duct stones, injury to nearby structures, blood clots and complications of anaesthesia. Injury to the main bile duct is uncommon but important. Your surgeon should discuss your individual benefits, alternatives and risks before you consent.
Recovery after keyhole surgery
Most patients walk and drink within hours of surgery. Mild abdominal soreness, temporary bloating and shoulder-tip discomfort from the gas used during laparoscopy are common in the first few days.
Many people with desk-based work return within one to two weeks, while heavier work and strenuous exercise may require longer. Recovery varies with the severity of the disease, the operation performed, general health and the surgeon’s advice.
Seek medical advice after surgery if you develop increasing abdominal pain, fever, repeated vomiting, worsening wound redness or discharge, jaundice, breathing difficulty or marked swelling of a leg.
Can you live normally without a gallbladder?
Yes. The liver continues to make bile, which flows directly into the intestine. Most people return to a normal diet. Some experience temporary loose stools, bloating or intolerance of very fatty meals, which often improves as the body adjusts.
Diet and prevention
No diet can reliably remove gallstones that have already formed. If certain foods trigger pain while you await treatment, smaller and lower-fat meals may reduce attacks, but they do not cure the condition.
You cannot prevent every gallstone, but the following habits may reduce risk and support general health:
- Maintain a healthy weight
- Lose weight gradually rather than through crash diets
- Eat a balanced, fibre-rich diet
- Limit frequent large, fried or very fatty meals
- Stay physically active
- Manage diabetes and abnormal blood fats with medical advice
Common questions
Can medicines dissolve gallstones?
Medicines can dissolve a limited type of cholesterol stone in selected patients, but treatment is slow and stones often recur. They are not suitable for most people with symptomatic gallstones.
Do gallbladder flushes remove stones?
There is no reliable evidence that “flushes” or cleanses remove gallstones. They may delay proper diagnosis and treatment.
Will gallstones return after the gallbladder is removed?
Gallbladder stones cannot recur once the gallbladder has been removed. Rarely, stones may remain in or later form within the bile ducts.
Should every person with gallstones have surgery?
No. Silent gallstones usually need no treatment. Surgery is generally advised when stones cause typical symptoms or complications, or when specific higher-risk features are present.
Key message
Gallstones are common and often harmless, but repeated biliary pain, fever, jaundice or persistent vomiting should never be ignored. An ultrasound usually confirms gallbladder stones, and laparoscopic gallbladder removal provides effective treatment for most symptomatic patients. Planned assessment and treatment are preferable to waiting for an emergency.
Consult a gallstone surgeon in Lahore
If you have gallstone symptoms or an ultrasound showing gallstones, Prof. Dr. Zahid Mahmood can review your symptoms and scans and advise whether observation, further testing or laparoscopic surgery is appropriate.
For an appointment, call 0300 413 0159 or visit professorzahid.com.
This article is for general education and does not replace personal medical assessment. If you have severe pain, fever, jaundice or feel seriously unwell, seek urgent medical care.
Medical references
- Williams NS, O’Connell PR, McCaskie AW, editors. Bailey & Love’s Short Practice of Surgery. 28th ed. CRC Press; 2023. Chapter 71, “The gallbladder and bile ducts,” pp. 1243–1252.
- Yokoe M, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences. 2018;25(1):41–54.