Every week in clinic I meet at least one person who has just had their first ultrasound for something else — a back ache, a routine health check, a kidney stone scan — and discovered that they have gallstones they didn't know about. The radiologist's report comes with a sentence that quietly upends their week: "multiple calculi in the gallbladder. Surgical consultation advised." They walk in worried, expecting to be told they need surgery tomorrow.
The honest answer is: maybe, maybe not. Gallstone surgery has become so safe and routine that the temptation is to remove every gallbladder we find stones in. But that's not how good surgery is practised. The decision rests on whether your stones are causing problems or are likely to. This article walks through what a surgeon actually weighs before recommending an operation.
What are gallstones, in plain language?
Your gallbladder is a small pear-shaped sac tucked under your liver. It stores and concentrates bile — a fluid your liver makes to digest fat. Every time you eat a fatty meal, your gallbladder squeezes some of that concentrated bile into your intestines.
Gallstones form when bile becomes chemically imbalanced — usually too much cholesterol relative to the other ingredients. The cholesterol crystallises and gradually builds into stones. They can be sand-grain small or marble-sized. People with stones can have anywhere from one stone to several dozen.
It's a remarkably common condition. Roughly one in ten Indian adults has gallstones, often without knowing. South Indian women in their forties are over-represented — a combination of genetics, diet patterns and oestrogen exposure. None of which means surgery is automatically needed.
When stones genuinely need surgery
These are the clinical pictures where we recommend gallbladder removal without much hesitation.
- You've had a typical attack of gallstone pain (biliary colic). A sharp, gripping pain in the upper right abdomen or below the right shoulder blade, lasting 30 minutes to several hours, often after a rich meal. Once you've had one such attack, the chance of repeated attacks within two years is high.
- You've had acute cholecystitis — an inflamed, infected gallbladder. This is fever plus persistent right-upper-abdomen tenderness. We usually treat the inflammation with antibiotics and schedule surgery on the same admission or within 4 to 6 weeks.
- A stone has migrated into the bile duct (choledocholithiasis), often causing jaundice. The duct stone is cleared by an endoscopic procedure (ERCP), and the gallbladder is removed soon after to prevent more stones travelling down.
- Gallstone pancreatitis — the pancreas gets inflamed when a stone briefly blocks the joint outlet with the bile duct. Surgery is essential, usually within the same hospital stay.
- Porcelain gallbladder — when the gallbladder wall calcifies, the risk of gallbladder cancer rises sharply. Surgery is advised even without symptoms.
- Stones larger than 2.5 cm or a single stone with thick gallbladder wall — both raise the long-term cancer risk slightly.
- Diabetics with stones, even if asymptomatic, because complications are more severe and harder to recover from. We discuss this case by case.
When you can safely leave them alone
Many gallstones never cause trouble in a lifetime. If you are a healthy adult with gallstones found incidentally on a scan and you have none of the following — repeated right-upper-abdomen pain, jaundice, fever, episodes of pancreatitis, very large stones, diabetes, porcelain wall — then watchful waiting is reasonable. The chance of a silent stone causing trouble each year is around 1 to 2 percent, and most adults who do develop symptoms have plenty of time to seek elective surgery.
What watchful waiting looks like in practice: an annual ultrasound, a sensible diet, and a clear plan to come in fast if you do develop typical symptoms. We give patients a short list of red flags and a direct WhatsApp number. The arrangement works well.
Can gallstones be dissolved or flushed out?
Patients often ask about oral medication to dissolve stones, ayurvedic preparations, or "gallbladder cleanses." Here's the honest position. Specific bile-acid drugs (ursodeoxycholic acid) can slowly dissolve some pure cholesterol stones, but the process takes 6 to 24 months, and stones recur in about half of patients once the medication is stopped. For most symptomatic adults, the medication route is far slower and less reliable than surgery.
"Liver flushes" with olive oil and lemon juice produce green pellets in the stool — these are usually saponified oil, not stones. There is no scientific evidence that this technique clears actual gallstones, and it has caused serious complications in patients with bile duct disease. Skip it.
What the modern surgery actually looks like
Laparoscopic cholecystectomy — keyhole gallbladder removal — has been the gold standard for over two decades. At our hospital it is a day-care or short-stay procedure for most patients. Here's the typical sequence:
- You arrive in the morning fasting. Pre-op tests are quick if already done.
- General anaesthesia. The surgery itself takes 30 to 45 minutes.
- Three or four small cuts of 5 to 10 mm, mostly above the navel.
- The cystic duct and artery are clipped, the gallbladder is freed from the liver, and it is brought out through one of the ports along with all the stones.
- You wake up in recovery within an hour. By evening you are walking, eating dinner, and most patients go home the next morning.
- Stitches dissolve. A follow-up at one week, another at one month, and you're done.
Recovery is gentle. Most desk-job patients are back at work in 5 to 7 days. Heavy lifting can wait two weeks. There is no special long-term diet — once you've healed, you can eat as you did before, just with the small caveat that your bile is now dripping into the intestine continuously rather than being released in big squeezes. Most people don't notice the difference. A small minority report slightly looser stools for the first few months, which usually settles. For more on what to eat in the immediate recovery window, see our first-week post-surgery diet plan.
What if I leave it and develop a complication?
The complications of untreated symptomatic gallstones — acute cholecystitis, bile-duct stones with jaundice, gallstone pancreatitis — are each significantly more dangerous than elective surgery would have been. A scheduled day-care procedure has a complication rate well under 1 percent in experienced hands. An emergency operation on an inflamed, friable gallbladder carries higher risks, longer hospital stay and a longer convalescence. Where the diagnosis is clear and symptoms have started, planning the operation calmly is usually the lower-risk path.
How we decide together
If you've been told you have gallstones, here's how a typical consultation with us runs. We'll ask about specific symptoms — when, how often, what brings them on, what helps. We'll examine you. We'll look at your ultrasound report and sometimes get a clearer scan. We'll ask about diabetes, family history of gallbladder cancer, and what your daily life looks like. Then we will lay out two or three options with honest risks and benefits, and give you the time to think and ask. Book a consultation when you're ready — bring all your reports, and a family member if you'd like a second pair of ears.
Frequently asked questions
Are silent gallstones dangerous?
Most are not. The annual risk of a silent stone becoming symptomatic is around 1 to 2 percent. Diabetics, very large stones and porcelain gallbladders are exceptions.
Will I be able to eat fatty food after surgery?
Yes, in most cases. The body adapts quickly. We do suggest moderate fat for the first month while your digestion settles.
Can I live a normal life without a gallbladder?
Completely. The gallbladder is a storage organ — your liver still makes bile, it just drips continuously into the intestine instead of releasing big squeezes.
Is laparoscopic surgery painful?
Less than open surgery, but expect manageable soreness for 3 to 5 days. See our comparison guide for details.
Final word
Gallstones are common, often silent, sometimes serious. The decision to operate is not automatic — it should be made on your specific picture and your specific goals. If you've been handed a "surgery advised" note from a scan you didn't expect to be looking at, breathe, and come in for an honest conversation. Many of our patients walk out reassured that they don't need surgery yet. The ones who do, leave with a clear plan and a fixed estimate.