How can gallstones be treated?

Various painkillers and antispasmodic medications can relieve painful colic. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are particularly effective. They help more than antispasmodic medications do. Symptoms like bloating or nausea can also be treated with medicine.

Medications are not commonly used to remove gallstones. That can only be done with small, newly formed cholesterol stones inside the gallbladder. These gallstones can be dissolved using tablets containing a bile acid called ursodeoxycholic acid (UDCA). The tablets usually have to be taken for several months. But new gallstones often form after the treatment is over. So this treatment is only considered in a small number of people who have mild symptoms or rare episodes of colic.

Ursodeoxycholic acid (UDCA) can cause blood counts to increase that are a sign of changes in the liver or bile ducts. They should be monitored during treatment. Some people also report that their stool becomes mushy and they have diarrhea more often.

Removing the gallbladder is the only way to permanently prevent painful colic if there are gallstones in the gallbladder. The decision whether and when to have surgery will depend on various aspects:

• What are the chances that the symptoms will reappear? While many people have symptoms very frequently, others have them rarely or only once.
• How bad are the symptoms? Do the gallstones cause severe upper abdominal pain and colic, or milder symptoms?
• How sure are the doctors that the symptoms are being caused by gallstones? If you have upper abdominal pain and colic, gallstones are very likely to be causing it. Symptoms such as digestion problems often have other causes.
• How high is the risk of complications such as gallbladder inflammation?
• What is your personal risk from surgery? Some people may have a higher risk of complications from the surgery because of their age or other medical conditions, for instance.

In Germany, people who decide to have surgery can look for a hospital in the "White List" (a reference guide called the "Weisse Liste" in German) to find out how often they perform this kind of operation.

Nowadays, gallbladders are usually removed using keyhole surgery in a procedure called laparoscopy. This involves making 3 to 4 small cuts (incisions) in the abdominal wall under general anesthesia. The surgeon inserts thin tubes through these cuts so that small instruments can be moved along them to reach the gallbladder.

You usually have to stay in hospital for 2 to 3 days. Unless there's a medical reason not to, the procedure can also be performed as day surgery, so you can go home on the same day. You can recover from surgery just as well at home as in the hospital, and the risk of complications is about the same. You should take it easy in the first two weeks after surgery and avoid heavy lifting and strenuous sports such as soccer for about four weeks after.

Open abdominal surgery is only rarely needed to remove the gallbladder, such as if problems occur during laparoscopy. It takes longer to recover from open surgery than from laparoscopy. Inflammation of the surgical wound is also more common.

In Germany, hospitals are required to record data about how often complications arise following certain procedures. About 1,000 hospitals have reported this data for gallbladder removal. The latest statistics (from 2021) show the following:

• The bile duct is damaged during about 1 out of 100 procedures. These serious complications lead to problems like inflammation in the abdomen. Further treatment is then needed.
• Bleeding needing treatment or infections occur in about 4 out of 100 procedures. But they can usually be treated effectively and often cause no complications.

Gallstones only rarely develop in the bile duct itself. Most bile duct stones form in the gallbladder and enter the bile duct from there.

Bile duct stones are more likely than gallbladder stones to lead to inflammation of the bile ducts and pancreas. But they can break away and pass into the small intestine on their own without causing any problems, so they don’t always need to be treated. You can talk with your doctor about whether they have to be removed.

Bile duct stones can be removed using endoscopic retrograde cholangiopancreatography (ERCP). Under short anesthetic (sedation), an endoscope is gently pushed through your mouth, stomach and small intestine to reach the bile ducts. Then a contrast agent (a dye-like substance) is injected so that doctors can see the bile ducts in an x-ray. An incision is then often made in the opening to the bile ducts. The stones are removed with a small basket or loop inserted through the endoscope.

In about 5 to 10 out of 100 people, ERCP causes complications like pancreatitis and damage to the bile duct or gastrointestinal tract. ERC can be performed in hospital or as an outpatient procedure.

Special surgery is needed to remove the gallbladder if there are also bile duct stones.

Many people who are going to have surgery wonder what it is like to live without a gallbladder. Not having a gallbladder is generally not associated with any major disadvantages. Without a gallbladder, all of the bile produced in the liver flows directly into the small intestine through the common bile duct, without being stored first. Some people have to empty their bowels more frequently as a result, and their stool may be looser. Diarrhea can also be more common.

Although the colic usually stops after surgery, there is no guarantee that the symptoms will go away completely. For instance, you might still feel bloated and full, or experience flatulence. And other gallstones could develop in the bile ducts, causing problems.

People don't necessarily have to change their diet or follow a special diet after surgery. Many can carry on eating what they ate before, without any problems.

If certain foods lead to digestion problems after surgery, it may be a good idea to make a few changes to your diet. Your doctor can help you. People are often advised to cut down on fats and eat more fiber. Trial and error is the best way to find out which foods agree with you, and which do not.