Treatment

Your treatment plan for gallstones depends on how the symptoms are affecting your daily life.

If you don't have any symptoms, active monitoring is often recommended. This means you won't receive immediate treatment, but you should let your GP know if you notice any symptoms.

As a general rule, the longer you go without symptoms, the less likely it is that your condition will get worse.

You may need treatment if you have a condition that increases your risk of developing complications, such as:

• scarring of the liver (cirrhosis)
• high blood pressure inside the liver (this is known as portal hypertension and is often a complication of alcohol-related liver disease)
• diabetes

Treatment may also be recommended if a scan shows high levels of calcium inside your gallbladder, as this can lead to gallbladder cancer in later life.

If you have episodes of abdominal pain (biliary colic), treatment depends on how the pain affects your daily activities.

If the pain is mild and infrequent, you may be prescribed painkillers to control further episodes and be given advice about eating a healthy diet to help control the pain.

If your symptoms are more severe and frequent, surgery to remove the gallbladder is usually recommended.

The gallbladder isn't an essential organ and you can lead a normal life without one.

Some people may experience symptoms of bloating and diarrhoea after eating fatty or spicy food. If certain foods trigger symptoms, you may wish to avoid them in the future.

Keyhole surgery to remove the gallbladder

If surgery is recommended, you'll usually have keyhole surgery to remove your gallbladder. This is known as a laparoscopic cholecystectomy.

During a laparoscopic cholecystectomy, 3 or 4 small cuts are made in your abdomen.

One larger cut (about 2 to 3cm) is made by the belly button and the others (each 1cm or less) will be on the right side of your abdomen.

Your abdomen is temporarily inflated using carbon dioxide gas. This is harmless and makes it easier for the surgeon to see your organs.

A laparoscope (a long, thin telescope with a tiny light and video camera at the end) is inserted through one of the cuts in your abdomen.

This allows your surgeon to view the operation on a video monitor. They'll remove your gallbladder using special surgical instruments.

If it's thought there may be gallstones in the bile duct, an X-ray or ultrasound scan of the bile duct is also taken during the operation.

If gallstones are found, they may be removed during keyhole surgery. If the operation can't be done this way, or an unexpected complication occurs, it may have to be converted to open surgery.

After the gallbladder has been removed, the gas in your abdomen escapes through the laparoscope and the cuts are closed with dissolvable stitches and covered with dressings.

Laparoscopic cholecystectomies are usually carried out under a general anaesthetic, which means you'll be unconscious during the procedure and won't feel any pain while it's carried out.

The operation takes 60 to 90 minutes and you can usually go home the same day.

Full recovery typically takes around 10 days.

Single-incision keyhole surgery

Single-incision laparoscopic cholecystectomy is a newer type of keyhole surgery used to remove the gallbladder.

During this type of surgery, only 1 small cut is made, which means you'll only have a single scar.

But as this type of cholecystectomy hasn't been carried out as often as conventional cholecystectomies, there are still some uncertainties about it.

Access to single-incision laparoscopic cholecystectomies is also limited because it needs an experienced surgeon with specialist training.

Read more about single-incision laparoscopic cholecystectomy on the National Institute for Health and Care Excellence (NICE) website

Open surgery

A laparoscopic cholecystectomy may not be recommended if you:

• are in the third trimester (the last 3 months) of pregnancy
• are extremely overweight
• have an unusual gallbladder or bile duct structure that makes a keyhole procedure difficult and potentially dangerous

In these circumstances, an open cholecystectomy may be recommended.

A 10 to 15cm (4 to 6in) incision is made in the abdomen, underneath the ribs, so the gallbladder can be removed.

General anaesthetic is used, so you'll be unconscious and won't feel any pain.

Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time and causes more visible scarring.

Most people have to stay in hospital for up to 5 days. It typically takes 6 weeks to fully recover.

Read more about recovering from gallbladder surgery.

Endoscopic retrograde cholangio-pancreatography (ERCP)

Endoscopic retrograde cholangio-pancreatography (ERCP) is a procedure that can be used to remove gallstones from the bile duct.

The gallbladder isn't removed during this procedure, so any stones in the gallbladder will remain unless they're removed using other surgical techniques.

ERCP is similar to a diagnostic cholangiography (see diagnosing gallstones for more information), where an endoscope (a long, thin flexible tube with a camera at the end) is passed through your mouth down to where the bile duct opens into the small intestine.

But during ERCP, the opening of the bile duct is widened with a small cut or an electrically heated wire.

The bile duct stones are then removed or left to pass into your intestine and out of your body.

Sometimes a small tube called a stent is permanently placed in the bile duct to help the bile and stones pass.

ERCP is usually carried out under sedation, which means you'll be conscious throughout the procedure but won't experience any pain.

The procedure lasts about 30 minutes on average, but can take from 15 minutes to over an hour.

Afterwards, you may need to stay in hospital overnight so you can be monitored.

Medicine to dissolve gallstones

If your gallstones are small and don't contain calcium, it may be possible to take ursodeoxycholic acid tablets to dissolve them.

But these aren't prescribed very often because:

• they're rarely very effective
• they need to be taken for a long time (up to 2 years)
• you can get gallstones again after treatment is stopped

Side effects of ursodeoxycholic acid are uncommon and are usually mild. The most commonly reported side effects are feeling sick, being sick and itchy skin.

Ursodeoxycholic acid isn't usually recommended for pregnant or breastfeeding women.

Sexually active women should either use a barrier method of contraception, such as a condom, or a low-dose oestrogen contraceptive pill while taking ursodeoxycholic acid, as it may affect other types of oral contraceptive pills.

Ursodeoxycholic acid tablets may occasionally be used to prevent gallstones if it's thought you're at risk of developing them.

For example, ursodeoxycholic acid may be prescribed if you have recently had weight loss surgery, as rapid weight loss can cause gallstones to grow.

Diet and gallstones

In the past, people with gallstones who weren't suitable for surgery were sometimes advised to adopt a very low-fat diet to stop the gallstones growing.

But recent evidence suggests this isn't helpful because rapid weight loss resulting from a very low-fat diet can actually cause gallstones to grow.

This means that if surgery isn't recommended or you want to avoid having an operation, it's advisable to adopt a healthy, balanced diet based on The Eatwell Guide.

This involves eating a variety of foods, including moderate amounts of fat, and having regular meals.

A healthy diet won't cure gallstones or completely eliminate your symptoms, but it can improve your general health and help control pain caused by gallstones.

Read more about healthy eating.