Gallbladder Stones and Gallbladder Surgery: Symptoms, Diagnosis and Treatment

What Is the Gallbladder and What Does It Do?

The gallbladder is a small organ located just beneath the liver. Its role is to store and concentrate the bile produced by the liver. Bile is involved above all in the digestion of fats.

When we eat, the gallbladder contracts and sends the stored bile through the bile ducts into the small intestine.

One of the most common conditions affecting the gallbladder is gallbladder stones, known medically as cholelithiasis. In some people gallstones cause no symptoms at all, while in others they can lead to severe pain, gallbladder inflammation, jaundice or pancreatitis — all potentially serious problems.

What Are Gallbladder Stones?

Bile contains cholesterol, bile pigments, bile salts and various other substances. When the balance of these substances is disturbed, crystals can form within the bile. Over time these crystals can grow and turn into gallstones.

The size and number of gallstones vary from person to person. There may be a single large stone or many small ones.

However, the size of a stone alone does not indicate how serious the condition is. Small stones in particular can leave the gallbladder, pass into the common bile duct and cause serious complications.

Why Do Gallbladder Stones Form?

There is no single cause of gallstone formation. Age, genetic predisposition, body weight, metabolic factors and certain diseases can all influence the development of gallstones.

Obesity is one of the important risk factors for gallstone formation. In addition, rapid weight loss can also increase the risk of developing gallstones. This is why gallbladder stones may develop in some patients who lose weight rapidly after bariatric surgery.

Gallstones are seen more often in women, in older individuals, in people with a family history of gallstones and in those with certain metabolic diseases. However, gallbladder stones can also develop in people with no risk factors at all.

What Are the Symptoms of Gallbladder Stones?

Not everyone with gallbladder stones has complaints. Stones that cause no symptoms are sometimes discovered incidentally during an ultrasound performed for another reason. These are called asymptomatic gallstones.

Among symptomatic gallstones, one of the most typical complaints is pain in the upper right or upper middle part of the abdomen. The pain may begin especially after fatty or heavy meals. It can sometimes radiate to the back or the right shoulder area. Nausea and vomiting may accompany it.

The typical pain attacks caused by gallbladder stones are called biliary colic.

However, since abdominal pain can have many different causes, it is not correct to diagnose gallstones based on the location of the pain alone.

What Is Gallbladder Inflammation?

When a gallbladder stone blocks the outlet of the gallbladder, acute cholecystitis — inflammation of the gallbladder — can develop. In this case the pain usually lasts longer and can be severe. Fever, nausea, vomiting and abdominal tenderness may occur.

Unlike a simple gallstone attack, acute cholecystitis is a condition that requires medical evaluation and treatment. The timing of treatment is determined by the patient’s general condition and the characteristics of the disease.

In suitable patients, laparoscopic gallbladder surgery is an important part of the treatment of acute cholecystitis.

What Happens If a Gallstone Falls into the Common Bile Duct?

One of the stones in the gallbladder can leave the gallbladder and pass into the common bile duct. Stones in the common bile duct are called bile duct stones, or medically, choledocholithiasis.

In this situation the flow of bile can be obstructed. The patient may develop yellowing of the eyes and skin, darkening of the urine, abdominal pain and abnormal liver test results. If infection accompanies the blockage in the bile duct, a serious condition called cholangitis can develop.

Depending on the patient, methods such as MRCP, endoscopic ultrasound and ERCP can be used in the treatment of bile duct stones.

Having stones in the gallbladder and having stones in the common bile duct are not the same condition, and the treatment plan must be made accordingly.

Can a Gallstone Cause Pancreatitis?

Yes. A small stone leaving the gallbladder can block the flow at the point where the bile and pancreatic ducts join the intestine, causing acute pancreatitis. This is called biliary pancreatitis, or gallstone pancreatitis.

Acute pancreatitis is an important clinical condition that may require hospital evaluation and treatment.

In patients who have had gallstone-related pancreatitis, planning treatment of the gallbladder once the patient’s clinical condition allows is important for preventing new attacks.

How Are Gallbladder Stones Diagnosed?

The most commonly used method for diagnosing gallbladder stones is ultrasound. Ultrasound can show gallbladder stones, changes in the gallbladder wall and, in some cases, dilation of the bile ducts.

If stones are suspected in the common bile duct, however, additional investigations may be needed. Blood tests can be used to assess liver function, bilirubin levels and markers of infection. In selected patients, advanced methods such as MRCP, endoscopic ultrasound or ERCP may be used.

Not every gallstone patient needs the same set of tests.

Does Everyone with Gallbladder Stones Need Surgery?

No. Not every patient with gallstones found incidentally on ultrasound who has no complaints needs routine surgery. In asymptomatic gallstones, follow-up may be appropriate depending on the patient’s characteristics.

By contrast, surgical treatment comes onto the agenda in situations such as recurrent pain attacks caused by gallstones, acute cholecystitis, stones falling into the bile duct or gallstone-related pancreatitis.

For this reason, the answer to the question “I have a stone in my gallbladder — do I need surgery?” is not given based solely on the presence of a stone on ultrasound. The patient’s complaints, the complications caused by the stone and the patient’s general health must be evaluated together.

How Are Gallbladder Stones Treated?

The standard surgical treatment for symptomatic gallbladder stones is cholecystectomy — the removal of the gallbladder. Today the great majority of these operations are performed laparoscopically. The procedure is called laparoscopic cholecystectomy, popularly known as keyhole (closed) gallbladder surgery.

There is an important point here: in gallstone surgery, it is usually not only the stones that are removed. The gallbladder is removed together with the stones. The reason is not merely to eliminate the existing stones, but to remove the gallbladder in which the stones formed, thereby preventing new stones from forming in the same gallbladder.

How Is Laparoscopic Gallbladder Surgery Performed?

Laparoscopic gallbladder surgery is performed under general anesthesia. A camera and surgical instruments are inserted through small incisions in the abdomen.

The gallbladder’s blood vessel and bile duct are carefully identified, sealed and divided. The gallbladder is then freed from the liver bed and removed from the abdomen.

Correctly demonstrating the anatomy of the bile ducts during surgery is important. In some patients, severe inflammation, adhesions or anatomical variations can make the operation more difficult. In certain situations, conversion to open surgery may be necessary for patient safety. This does not mean the operation has “failed”; it can be a decision made in the interest of safe surgery.

How Long Does Gallbladder Surgery Take?

An uncomplicated laparoscopic cholecystectomy is generally a relatively short operation. However, the duration of surgery can vary from patient to patient.

Acute inflammation, previous abdominal operations, dense adhesions, anatomical variations or additional problems involving the bile ducts can prolong the operation. For this reason, it is not appropriate to state an exact operating time for every patient.

Can You Live Without a Gallbladder?

Yes. The gallbladder is not an organ that is essential for life. After the gallbladder is removed, the liver continues to produce bile.

The difference is that bile is no longer stored in the gallbladder and passes from the liver to the intestines in a more continuous fashion. The great majority of patients return to their normal lives after gallbladder surgery.

What Should Your Diet Be Like After Gallbladder Surgery?

The question patients most often ask about nutrition after gallbladder surgery is whether a special diet is required for life. In most patients, a strict lifelong “gallbladder diet” is not necessary.

In the early period after surgery, lighter meals in smaller portions that are not excessively fatty may be preferred. As the body adapts to the new situation, eating habits can gradually return to normal.

Some patients, particularly in the early period, may experience bloating after fatty meals or changes in bowel habits. Since food tolerance varies from person to person, post-operative recommendations should be tailored to the individual patient.

What Are the Risks of Gallbladder Surgery?

As with any surgical procedure, laparoscopic cholecystectomy carries certain risks. Bleeding, infection, bile leakage and anesthesia-related complications can occur. Injury to the bile ducts is a rare but important complication.

The risk of complications can be affected by factors such as acute inflammation, previous operations, the patient’s anatomy and general health. This is why pre-operative assessment and safe surgical technique are important.

What Is a Gallbladder Polyp?

Apart from gallstones, a gallbladder polyp may also be detected during ultrasound. The great majority of gallbladder polyps are benign, and small polyps can be monitored with ultrasound at regular intervals.

However, the size of the polyp, whether it is growing, the patient’s age and other accompanying risk factors can influence the decision for surgery. For this reason, the treatment decision for gallbladder polyps should not be made simply on the basis of “polyp present or absent.”

Can Gallstones Form After Obesity Surgery?

There is an important relationship between obesity and gallstones. In addition, the rapid weight loss that occurs after gastric sleeve or gastric bypass surgery can increase the risk of gallstone formation in some patients.

For this reason, gallbladder disease should be kept in mind when evaluating right upper abdominal pain that arises after bariatric surgery.

However, this does not mean that every patient who undergoes bariatric surgery needs routine removal of the gallbladder. The decision should be individualized, taking into account the patient’s existing gallstones, symptoms and clinical characteristics.

The Right Diagnosis Comes Before the Right Treatment for Gallstones

Although gallbladder stones are very common, they do not follow the same course in every patient. Some people live their whole lives unaware that they have gallstones, while others develop recurrent pain attacks, gallbladder inflammation, bile duct obstruction or pancreatitis.

For this reason, the treatment decision should not be based solely on the presence of stones on ultrasound. The patient’s complaints, examination findings, blood tests and imaging results must be evaluated together.

For symptomatic gallbladder stones that require surgical treatment, laparoscopic gallbladder surgery (laparoscopic cholecystectomy) is today the principal surgical treatment. The aim is not only to remove the existing stone but to properly treat the problems the stones have caused, or could cause in the future, for the patient.

Information Note

This content has been prepared for general information purposes. It is not a substitute for diagnosis or individual treatment advice. Decisions regarding gallbladder stones and gallbladder surgery should be made based on the patient’s clinical evaluation.

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