When is surgery required for gallstones?

The most important deciding factor for surgery is the presence or absence of symptoms related to the gallstone. It is common to pick up incidental gallstones on routine scans intended for other reasons. However, up to 80% of such gallstones are not producing any symptoms and are best left alone. For stones which are causing pain or discomfort, the current recommendation is surgical removal.

The reason for the above recommendation is essentially a balance between the potential benefit and harm with the surgical approach versus that of leaving the gallstones alone. If the benefit outweighs the risk, (as in gallstones causing symptoms) surgery is generally recommended.

One common challenge doctors face is attributing the symptoms to the gallstones to justify taking the surgical route. This is because problems such as gastritis, bloating and indigestion can some times mimic milder symptoms related to the gallstones. Having too low a threshold for surgery will risk over treatment and unnecessary complications. As such, many doctors may choose to watch over a period using medication until he or she is reasonable convinced the stone need to be taken out.

- Dr Quan

Surgery for gallstones is recommended when gallstones cause problems, meaning when patients have symptoms due to this condition.

Patients may experience pain in the upper abdomen and right upper side of the abdomen after food associated with nausea and vomiting.

Surgery is also recommended when complications like jaundice, fever, severe pain occur which are results of inflammation of gallbladder (cholecystitis), stone causing blockage of bile flow in bile duct and inflammation (cholangitis), or pancreatitis.

The recommendation regarding surgery for gallstones needs to be discussed with your doctor.

The decision for surgery in a patient with gallstones often needs to be taken in totality together with the patient's overall fitness for surgery. In addition, it is useful to determine whether a gallstone is mobile in the gallbladder or if it is still adherent to the gallbladder wall.

Only mobile gallstones can give rise to gallstone complications such as gallbladder outlet obstruction, migration that can cause obstruction to the bile duct (liver drainage system) or more dangerously, obstruction of the pancreatic duct.

In my practice, in my patients with gallstones, I usually perform a dynamic ultrasound examination myself to determine if the gallstone is mobile.