Gallstones and surgery: How to know when your gallbladder needs to be removed

A sudden wave of severe abdominal pain late at night or right after a heavy meal is often the very first warning sign of a gallbladder problem. The gallbladder is a small organ located beneath the liver, storing bile, which helps to digest food. In some cases, small formations known as gallstones appear within the organ. They may remain unnoticed for years without causing any symptoms, while in other cases, they block the passage of bile, causing pain. It is important to know when it is possible to treat gallstones in a non-surgical way and when surgical treatment is required.

When gallstone surgery is required?

Based on clinical experience, the need for gallstone surgery has been categorized into two types:

Silent (Asymptomatic) gallstones: When gallstones are detected by imaging without any symptoms, surgery is not required since the risks of surgery far exceed the advantages. These are simply incidental findings which require monitoring rather than surgery.

Symptomatic gallstones: Surgery becomes necessary as soon as gallstones cause pain or block the flow of digestive fluids.

Common signs when surgery is necessary

The primary indication for surgery is gallbladder colic or pain, which is called a gallbladder attack. Patients typically need surgical treatment if they experience:

Recurrent abdominal pain: Sudden and strong abdominal pain on the right side or the center of the abdomen occurring after consuming fatty foods. The duration of the pain is about 30 minutes or several hours and sometimes it radiates into the back or the right shoulder.

Inflammation of the gallbladder: Swollen, inflamed and infected gallbladder as a result of the permanent blockage of its duct by the stone, resulting in persistent, severe pain along with a high fever, chills, and nausea.

Blockage of the common bile duct: The common bile duct is the main pipe that drains bile from both the liver and gallbladder into the small intestine. If a gallstone leaves the gallbladder and gets stuck in this duct, bile backs up into the bloodstream. It leads to jaundice (yellowing of the skin and eyes), dark urine and pale stools.

Pancreatitis: Sometimes, the gallstones can obstruct the passage of food from the pancreas. This obstruction leads to acute inflammation of the pancreas, which needs immediate hospitalization and removal of the gallbladder.

What does surgery involve?

The surgical procedure to remove the gallbladder is called a cholecystectomy. Surgeons remove the entire organ because removing just the stones allows new ones to form later. Fortunately, the body works completely fine without a gallbladder; bile simply flows directly from the liver into the small intestine to digest food normally.

Most procedures today are performed using laparoscopic (keyhole) surgery. The surgeon makes a few tiny cuts in the patient's abdomen to remove the organ using a small camera and specialised mini-instruments. This technique results in minimal pain, small scars and a quick recovery, allowing most patients to go home the same day or the next day.

The mere presence of gallstones is not enough to necessitate any form of surgical intervention. Some individuals may never have to undergo any form of surgery, while other patients could require having their gallbladders removed permanently to prevent further occurrences of this condition. Understanding the condition and seeking medical advice when symptoms arise is important to ensure that patients receive the right treatment at the right time.

(The author is a general & laparoscopic surgery expert at Apollo Spectra Hospital, Bengaluru)

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.