Do gallstones always require surgery?

That stomach cramp might be a sign of something more serious, like gallstones. 

Gallstones are small stones that form in the gallbladder, a small organ that sits between your liver and pancreas. The stones can be as small as a grain of sand or as large as a golf ball.  

“Your gallbladder’s main purpose is to break down food using bile,” says Dr. Hanna Meidl, a general surgeon at Advocate Health Care. “When that process starts to malfunction due to high cholesterol or bilirubin buildup, it can cause gallstones to form and disrupt bile transport into the small intestine.” 

Gallstones often don’t present with any symptoms and are found during routine x-rays, abdominal surgery or other medical procedures. If you do experience symptoms, they might look like: 

• Abdominal pain, typically in the upper right section below the ribs. It can also radiate to the back or right shoulder 
• Nausea with occasional bouts of vomiting 
• Jaundice, due to the gallstones blocking the bile ducts 
• Fever and chills 
• Darkening of urine or stool 

“Persistent symptoms can often indicate a more severe case of gallstones,” says Dr. Meidl. “If so, then we’ll use ultrasounds, CT scans, blood tests or MRIs to see if we can detect the gallstones and then build a course of action to relieve your symptoms.” 

When do you need gallstone surgery? 

Gallstones often don’t present any symptoms, so your health care provider will most likely continue regular check-ups to make sure the gallstones don’t get any worse. Surgery is not always necessary for gallstones but may be necessary depending on how severe your symptoms are or the size of your gallstones. 

Common gallstone procedures can include: 

• Laparoscopic or robotic gallbladder removal, which involves small incisions in the abdomen to remove the gallbladder  
• Open gallbladder surgery, which requires a larger incision to remove the gallbladder 

“There are other procedures that may be used to help treat your gallstones,” says Dr. Meidl. “The main two are endoscopic retrograde cholangiopancreatography (ERCP) for when the gallstones are lodged in the bile duct, and lithotripsy, which uses shock waves to break up the gallstones so they can pass more easily. It is important to discuss these options with your health care provider to determine which procedure is right for you.” 

To prevent gallstones, focus on eating a healthy diet that promotes a healthy digestive system, getting regular exercise, limiting fried and fatty foods, and reducing your coffee intake.  

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