Gallstones

Silent stones vs symptomatic stones

If stones were found by chance on a scan and you have no typical pain, the risk of trouble is low, roughly 1–2% a year. Most people in this situation don't need surgery. There are exceptions, such as very large stones, a porcelain gallbladder or gallbladder polyps, and we'll check for those.

Once you've had a proper gallstone attack, further attacks and complications become much more likely, and removing the gallbladder is usually advised.

What a gallstone attack feels like

A steady, gripping pain in the upper-right or middle of the belly, often after a meal or at night, lasting from 30 minutes to a few hours. It may spread to the right shoulder or back. Pain with fever, jaundice or pain that won't settle needs urgent care.

Treatment

• Laparoscopic cholecystectomy (keyhole removal of the gallbladder) is the standard treatment for symptomatic stones. It's done by a surgeon.
• If a stone has moved into the bile duct, it's removed by ERCP, usually before the gallbladder operation.
• Tablets (UDCA) dissolve only small cholesterol stones, slowly, and stones often return. They suit very few people.

Myths worth clearing up

• "Lemon juice and olive oil flushes dissolve stones." They don't. What people pass after a flush is usually soap-like lumps formed from the oil.
• "Without a gallbladder I can't digest food." The liver makes bile; the gallbladder only stores it. Most people eat normally afterwards.
• "Can't the surgeon remove just the stone?" Stones re-form in a diseased gallbladder, so the whole gallbladder is removed.