How can gallstones be treated?

Photo of two women

Lots of people have gallstones without noticing them. If they do get symptoms, many people wonder what they should do: Wait and just treat the symptoms at first, or have surgery? The pros and cons of the various options depend on your personal situation.

If gallstones don't cause any problems, there's usually no need to treat them. And lots of people with gallstones only get cramp-like pains (colic) once, or they only return after a long time. It is often not clear whether gallstones are actually causing symptoms such as digestion problems. What's more, any treatment can have side effects, and surgery always carries certain risks.

Symptoms such as cramp-like pain can be relieved with medication. But they can only be prevented permanently with surgery to remove the gallbladder or stones from the bile ducts. Surgery is also considered as a treatment option for people who have very big gallstones that aren't causing any symptoms, and for people who have a porcelain gallbladder. This is a condition where the wall of the gallbladder is thicker and calcified. It is associated with a higher risk of gallbladder cancer.

Which medications can help?

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.

Surgery to remove the gallbladder – yes or no?

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 ?
  • 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.

It is good to know that

doctors who recommend gallbladder surgery have to inform you of your right to get a second medical opinion free of charge. Our decision aid on gallbladder surgery can also help you to weigh up the pros and cons of this kind of procedure.

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.

What does surgery to remove the gallbladder involve?

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.

What are the risks of gallbladder surgery?

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 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.

How are stones removed from the bile duct?

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 . 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 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 .

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.

How do people manage without a gallbladder?

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.

Ahmed I, Innes K, Brazzelli M et al. Protocol for a randomised controlled trial comparing laparoscopic cholecystectomy with observation/conservative management for preventing recurrent symptoms and complications in adults with uncomplicated symptomatic gallstones (C-Gall trial). BMJ Open 2021; 11(3): e039781.

Bagepally BS, Haridoss M, Sasidharan A et al. Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy. BMJ Open Gastroenterol 2021; 8(1): e000675.

Brazzelli M, Cruickshank M, Kilonzo M et al. Clinical effectiveness and cost-effectiveness of cholecystectomy compared with observation/conservative management for preventing recurrent symptoms and complications in adults presenting with uncomplicated symptomatic gallstones or cholecystitis: a systematic review and economic evaluation. Health Technol Assess 2014; 18(55): 1-101, v-vi.

Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen (DGVS), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV). Prävention, Diagnostik und Therapie von Gallensteinen (S3-Leitlinie, in Überarbeitung). AWMF-Registernr.: 021-008. 2017.

European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 2016; 65(1): 146-181.

Facciorusso A, Gkolfakis P, Ramai D et al. Endoscopic Treatment of Large Bile Duct Stones: A Systematic Review and Network Meta-Analysis. Clin Gastroenterol Hepatol 2023; 21(1): 33-44 e39.

Fraquelli M, Casazza G, Conte D et al. Non-steroid anti-inflammatory drugs for biliary colic. Cochrane Database Syst Rev 2016; (9): CD006390.

Gurusamy KS, Davidson BR. Gallstones. BMJ 2014; 348: g2669.

Hao XY, Shen YF, Wei YG et al. Safety and effectiveness of day-surgery laparoscopic cholecystectomy is still uncertain: meta-analysis of eight randomized controlled trials based on GRADE approach. Surg Endosc 2017; 31(12): 4950-4963.

Institut für Qualitätssicherung und Transparenz im Gesundheitswesen (IQTIG). Bundesauswertung Cholezystektomie (Erfassungsjahr 2021).

Keus F, Gooszen Hein G, van Laarhoven Cornelis JH. Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane Hepato-Biliary Group reviews. Cochrane Database Syst Rev 2010; (1): CD008318.

Latenstein CS, Wennmacker SZ, de Jong JJ et al. Etiologies of Long-Term Postcholecystectomy Symptoms: A Systematic Review. Gastroenterol Res Pract 2019: 4278373.

Singh AN, Kilambi R. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis. Surg Endosc 2018; 32(9): 3763-3776.

Xiong W, Li M, Wang M et al. The Safety of Laparoscopic Cholecystectomy in the Day Surgery Unit Comparing with That in the Inpatient Unit: A Systematic Review and Meta-Analysis. Biomed Res Int 2020: 1924134.

Zhao JJ, Syn NL, Chong C et al. Comparative outcomes of needlescopic, single-incision laparoscopic, standard laparoscopic, mini-laparotomy, and open cholecystectomy: A systematic review and network meta-analysis of 96 randomized controlled trials with 11,083 patients. Surgery 2021; 170(4): 994-1003.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas - either via our form or by We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Über diese Seite

Updated on July 18, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.