At a glance
- What the surgery does
- Removes the gallbladder, usually through small keyhole incisions. You can digest food normally without it.
- Why people consider it
- Repeated gallstone attacks, an inflamed gallbladder, or complications such as stones in the bile duct or pancreatitis.
- The main choices
- Silent gallstones usually don't need surgery.[1] For uncomplicated attacks, surgery or watchful management are both reasonable for some people.[2] For acute inflammation, early surgery is usually better.[4]
- What recovery involves
- Usually home the same day or the next morning, with a return to desk work within one to two weeks.
- What to ask your surgeon
- How sure they are your pain comes from the gallstones, whether waiting is reasonable, and how they make sure the bile duct is identified correctly.
The short version
- Gallstones that cause no symptoms usually don't need surgery. In a classic study, only about 1 in 5 people with silent gallstones developed pain over 15 years.[1]
- For typical gallstone attacks, surgery is the usual recommendation. But a large UK trial found that watching and managing symptoms gave similar quality of life to surgery over 18 months, and many people in the watch group never needed an operation within two years.[2]
- Pain doesn't always go away after removal. In a Dutch trial of people with gallstones and abdominal pain, only about 6 in 10 were pain-free a year later, whether or not surgeons were strict about who got surgery.[3]
- For acute inflammation of the gallbladder (acute cholecystitis), early surgery within days led to fewer complications and shorter hospital stays than waiting weeks.[4]
- Bile duct injury is the most feared complication. It's rare, about 1 in 200 in older US data, and careful technique is designed to prevent it.[9][10]
Gallstones and the gallbladder
The gallbladder is a small pouch under the liver that stores bile, a fluid that helps digest fat. After a meal it squeezes bile into the small intestine through the bile ducts.
Gallstones form when substances in bile, usually cholesterol, harden into stones. Many people never know they have them. Problems start when a stone blocks the gallbladder's outlet or a bile duct.[12][13]
- Biliary colic (a gallbladder attack): steady, severe pain in the upper right or middle of the belly, often after a meal, lasting from about half an hour to several hours.
- Acute cholecystitis: inflammation or infection of the gallbladder, with pain that doesn't settle, fever and tenderness. This usually means a hospital stay.[5]
- Stones in the bile duct can cause jaundice (yellow skin or eyes) or pancreatitis, and are often removed with an endoscope (ERCP) before or around the time of surgery.
Do you need surgery?
It depends on whether the stones are causing problems, and how sure your doctors are that your symptoms come from them.
Gallstones with no symptoms
Stones found by chance on a scan usually don't need surgery. In a long-term study of people with silent gallstones, the chance of developing gallstone pain was about 10% at 5 years, 15% at 10 years and 18% at 15 years, and no one died of gallstone disease.[1]
Typical gallstone attacks
Surgery is the standard recommendation once stones cause attacks, because attacks tend to come back and complications can follow. Still, the evidence leaves room for a choice. In the UK C-GALL trial of 434 adults with uncomplicated gallstone pain, quality of life over 18 months was the same with surgery as with watching and managing symptoms. By two years, about 30% of the watch group had needed surgery, and gallbladder-specific symptoms were somewhat better in the surgery group.[2]
Belly pain that may not be from the stones
Gallstones are common, so they're sometimes found in people whose pain comes from something else, such as reflux or irritable bowel syndrome. In the Dutch SECURE trial of 1,067 people with gallstones and abdominal pain, only 56% to 60% were pain-free a year later. Using stricter criteria to pick who got surgery led to fewer operations without more gallstone complications.[3] A review of 38 studies found upper belly pain persisted after removal in up to a third of patients.[11]
Classic gallstone pain is severe, lasts at least 15 to 30 minutes, sits in the upper middle or upper right belly, may spread to the back, and eases with simple painkillers. Pain that doesn't fit that pattern is worth discussing before surgery.[3]
If your gallbladder is inflamed
For acute cholecystitis, most guidelines recommend removing the gallbladder early, during the same hospital stay when it's safe to do so.[5]
The research in detail
In the German ACDC trial of 618 patients, surgery within 24 hours of admission led to far fewer complications than antibiotics first and surgery weeks later (about 12% versus 34%), with shorter hospital stays and lower costs.[4] A Cochrane review reached a similar conclusion that early surgery appears safe and shortens hospital stay.[6]
For people too frail for surgery, a drainage tube through the skin into the gallbladder is sometimes used. In the Dutch CHOCOLATE trial of high-risk patients who were still fit enough for surgery, removing the gallbladder led to far fewer major complications than drainage (12% versus 65%), and fewer repeat procedures.[7]
What happens during surgery
Almost all gallbladder removals today are laparoscopic (keyhole): three or four small incisions, a camera, and long instruments. A Cochrane review found keyhole and open surgery had similar death and complication rates, with keyhole surgery meaning a shorter hospital stay and faster recovery.[8] Some surgeons use a robot, and a small number of operations need to switch to an open incision for safety.
The surgeon separates the gallbladder from the liver and clips the small duct and artery that connect it. The most important step is identifying those structures correctly so the main bile duct isn't mistaken for the gallbladder's duct. Surgeons use a method called the "critical view of safety" for this.[10][14] Some also take an X-ray of the bile ducts with dye during surgery (a cholangiogram). In US Medicare data from the 1990s, bile duct injuries were less common when a cholangiogram was used.[9]
Most people having a planned operation go home the same day or the next morning.
Recovery
- Days 1 to 3Soreness at the incisions and sometimes shoulder-tip pain from the gas used to inflate the belly. Walking helps. Many people need only over-the-counter pain medicine after the first days.
- Week 1 to 2Most people return to desk work and daily activities. Driving once you're off strong pain medicine and can brake hard comfortably.
- Weeks 2 to 6Gradual return to exercise and heavier lifting as your surgeon advises.
Life without a gallbladder
You don't need a gallbladder to digest food. Bile flows straight from the liver into the intestine instead of being stored. Most people eat normally. Some notice looser stools or diarrhea, gas or bloating after surgery, which often settles over time.[11] There's no special diet you must follow, though some people feel better with smaller, lower-fat meals at first.[12][15]
Risks and complications
- Bile duct injury. Rare but serious, and may need further surgery. In US Medicare data it happened in about 0.5% of operations.[9] Ask how your surgeon confirms the anatomy before cutting.[10][14]
- Bile leak from the clipped duct or the liver bed, often treated with an endoscopic procedure.
- Retained stones left in the bile duct, which may cause pain or jaundice later and are usually removed by endoscopy.
- Bleeding, infection, and hernias at incision sites.
- Persistent symptoms. Pain, bloating or diarrhea can continue or start after surgery, which is why it's worth being sure your symptoms are from the gallbladder.[3][11]
Questions to ask your surgeon
- How sure are you that my symptoms are coming from my gallstones?
Why we ask: Gallstones are common, and other conditions can cause similar pain. In one large trial, only about 6 in 10 people with gallstones and pain were pain-free a year after surgery. Do you need surgery?
- Is it reasonable for me to wait and see, and what would make you recommend surgery sooner?
Why we ask: A UK trial found similar quality of life with surgery or watchful management over 18 months for uncomplicated gallstone pain. Complications change the picture. Do you need surgery?
- Do I have any signs of stones in my bile duct, and will I need an ERCP?
Why we ask: Stones in the bile duct can cause jaundice or pancreatitis and are often removed with an endoscope before or around surgery. Gallstones and the gallbladder
- Will you do this laparoscopically or robotically, and how often do you need to switch to open surgery?
Why we ask: Almost all gallbladder removals are keyhole. Occasionally surgeons switch to an open incision for safety. What happens during surgery
- How do you make sure the bile duct is identified correctly? Do you use a cholangiogram?
Why we ask: Bile duct injury is rare but serious. Surgeons use a step called the critical view of safety and sometimes an X-ray of the ducts during surgery. What happens during surgery
- If my gallbladder is inflamed now, should it come out during this hospital stay?
Why we ask: Early surgery for acute cholecystitis led to far fewer complications and shorter stays than waiting weeks in a large trial. If your gallbladder is inflamed
- Will I go home the same day?
Why we ask: Most planned operations are day cases or one night. Knowing ahead helps you arrange a ride and help at home.
- Will I need to change how I eat afterward?
Why we ask: Most people eat normally. Some notice looser stools or bloating for a while. Recovery
Print this page or save it to your phone, and write down the answers during your visit.
Understanding your surgical technology options
The companies that make the implants and devices used in this surgery, compared side by side with FDA records and sources, plus recent research and FDA news explained for patients.
Recovery supplies
We list recovery supplies at every budget, from gel ice wraps to cold therapy machines, with what to look for in each.
- Comfort after belly surgery
- Easy food and drink
- Bowel and stomach comfort
- Walking
Sources
- Gracie WA, Ransohoff DF. The natural history of silent gallstones: the innocent gallstone is not a myth. N Engl J Med. 1982;307:798-800. https://pubmed.ncbi.nlm.nih.gov/7110244/
- Innes K, Ahmed I, et al. Laparoscopic cholecystectomy versus conservative management for adults with uncomplicated symptomatic gallstones: the C-GALL RCT. Health Technol Assess. 2024;28(26):1-151. https://doi.org/10.3310/MNBY3104
- van Dijk AH, et al. Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial. Lancet. 2019;393:2322-30. https://doi.org/10.1016/S0140-6736(19)30941-9
- Gutt CN, et al. Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study). Ann Surg. 2013;258:385-93. https://doi.org/10.1097/SLA.0b013e3182a1599b
- Okamoto K, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25:55-72. https://pubmed.ncbi.nlm.nih.gov/29045062/
- Gurusamy KS, et al. Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev. 2013;6:CD005440. https://pubmed.ncbi.nlm.nih.gov/23813477/
- Loozen CS, et al. Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial. BMJ. 2018;363:k3965. https://doi.org/10.1136/bmj.k3965
- Keus F, et al. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. 2006;4:CD006231. https://pubmed.ncbi.nlm.nih.gov/17054285/
- Flum DR, et al. Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA. 2003;289:1639-44. https://doi.org/10.1001/jama.289.13.1639
- Strasberg SM, et al. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995;180:101-25. https://pubmed.ncbi.nlm.nih.gov/8000648/
- Lamberts MP, et al. Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness. Surg Endosc. 2013;27:709-18. https://doi.org/10.1007/s00464-012-2516-9
- National Institute of Diabetes and Digestive and Kidney Diseases. Gallstones. https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones
- MedlinePlus (US National Library of Medicine). Gallstones. https://medlineplus.gov/gallstones.html
- SAGES. The SAGES Safe Cholecystectomy Program. https://www.sages.org/safe-cholecystectomy-program/
- American College of Surgeons. Cholecystectomy: surgical removal of the gallbladder (patient education). https://www.facs.org/for-patients/the-day-of-your-surgery/cholecystectomy/
Spot an error? Tell us and we'll check it and fix it.