How can gallstones be treated?

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A lot 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? Read about the advantages and disadvantages of the different treatment options.

If gallstones don't cause any problems, then there's usually no need to treat them. A lot of people with gallstones don't have any symptoms for a long time. What's more, any treatment can have side effects, and surgery always carries certain risks. Gallstones in the gallbladder are treated differently than stones in the bile ducts.

Symptoms such as cramping pain (colic) can be relieved with medicine. But the surgical removal of the gallbladder is the only way to prevent this pain in the long term. 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.

What are the pros and cons of surgery?

Removing the gallbladder is the only way to permanently prevent the painful colic caused by gallbladder stones. The decision of 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 problems with digestion often have other causes.
  • How high is the risk of complications such as of the gallbladder?
  • What are the advantages and disadvantages of 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.

Laparoscopy or open surgery?

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 very small instruments can be moved along them to reach the gallbladder.

Unless there's a medical reason not to, the procedure can 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.

Open surgery requiring a hospital stay is only rarely necessary when removing the gallbladder. But some people may have open surgery if, for instance, they have complications or adhesions in their abdomen. It takes longer to recover from open surgery than from laparoscopy. There's no that laparoscopy is associated with fewer complications, though.

What are the risks of surgery?

In Germany, hospitals are required to record data about how often complications arise following certain procedures. About 1,200 hospitals have reported this data for gallbladder removal. The latest statistics (from 2014) show the following:

Table: Risks of surgery
Type of complication (requiring treatment) Complications per 1,000 procedures (laparoscopy)
Bleeding 7
Bile duct injury 4
Other complications 14
Source: AQUA Institute 2015 (data from 2014)

Bile duct injuries can lead to problems like acute inflammation in the abdomen. If any scar tissue forms, it can narrow the bile duct. That may require long-term treatment.

How are bile duct stones removed?

Gallstones only rarely develop in the bile duct itself. Most bile duct stones form in the gallbladder and enter the bile duct from there. But bile duct stones are more likely than gallbladder stones to lead to of the bile ducts and . 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 are typically removed using a procedure called endoscopic retrograde cholangiography (ERC). It involves gently pushing an 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.

If there are other gallstones in the gallbladder too, the gallbladder can be surgically removed at a later time to prevent complications. In about 5 to 10 out of 100 people, ERC causes complications like pancreatitis and damage to the bile duct and gastrointestinal tract.

How are inflammations treated?

Acute gallbladder inflammations are usually caused by gallstones. The treatment is given at a hospital, involving and painkillers at first. Until the acute has gone away, you can't eat or drink anything, or only a small amount. You are put on a drip to make sure that your body gets enough fluids.

Immediate removal of the gallbladder (within one day) is recommended in order to stop the symptoms from coming back and prevent complications. If the is mild, surgery is sometimes not needed. But there isn't enough research on the long-term consequences of not having surgery. For example, it's not known how not having surgery affects the risk of severe complications. You could develop new inflammations and then need emergency surgery.

If the bile ducts are inflamed, there is a risk of pancreatitis or sepsis (blood poisoning). So the gallstones are removed from the bile ducts as quickly as possible using ERC.

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. But this is often only temporary.

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. And other gallstones could develop in the bile ducts, causing problems.

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

If certain foods lead to digestive 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.

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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. informedhealth.org 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.

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Updated on April 27, 2021
Next planned update: 2024

Authors/Publishers:

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

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