Gallstones: Symptoms, Risks, Myths & When Surgery Is Really Needed
Gallstones: Symptoms, Risks, Myths & When Surgery Is Really Needed
Gallstones are one of the most commonly diagnosed abdominal conditions today, often
detected incidentally during ultrasound scans. Despite this, there is widespread
confusion about who needs surgery and who does not.
“Gallstone treatment depends on symptoms — not on the size or number of stones.”
How Are Gallstones Diagnosed?
An abdominal ultrasound is the most sensitive and reliable investigation to diagnose
gallbladder stones. Gallstones are often discovered:
● During routine health check-ups
● While investigating unrelated issues like fever, gynecological problems, loose
stools, or other abdominal complaints
Types of Gallstone Patients
1 Symptomatic Gallstones (Biliary Colic)
This is the only symptom clearly attributable to gallstones.
Typical gallstone pain (biliary colic) has 7–8 classic features:
● Sudden onset
● Located in the upper abdomen or right side
● Moderate to severe intensity
● Often occurs late evening or at night
● Starts after a meal
● Lasts a few hours and settles on its own
● Radiates to the back or shoulder
● Associated with nausea or vomiting
This pain is usually very memorable, and patients can often recall the exact time and
day it occurred.
“Even a single episode of biliary colic mandates treatment, irrespective of stone size.”
2 Truly Asymptomatic Gallstones
These patients:
● Have stones detected incidentally
● Have no pain attributable to gallstones
● May have other abdominal symptoms unrelated to gallstones
They form the largest group of gallstone patients.
3 Patients With Atypical or Non-Specific Symptoms
Many patients have symptoms like:
● Gas, bloating, indigestion
● Burping, dyspepsia
● Constipation or diarrhea
● Vague abdominal discomfort
These symptoms are usually NOT caused by gallstones.
“Studies show that only about one-third of patients with atypical symptoms experience any relief
after gallbladder removal. Gallbladder surgery should not be done expecting relief from
indigestion or bloating.”
Does the Size or Number of Gallstones Matter?
No. Not at all. Gallstones are completely different from kidney stones.
● Kidney stones → size and number matter
● Gallstones → size and number are irrelevant
Gallstones are only a marker of gallbladder dysfunction. Treatment is directed at the
gallbladder, not the stones.
How Common Are Gallstones?
In parts of North India (UP, Bihar, West Bengal belt):
● Nearly 1 in 10 people (10%) have gallstones
● Most of them are asymptomatic
Natural History of Asymptomatic Gallstones
Large long-term studies following 40,000 patients over 30 years show:
● 90% never develop symptoms
● 10% develop symptoms
● Only 1% develop complications
“Most patients who developed complications first had gallstone pain.”
Gallstone Complications (Mainly After
Symptoms Begin)
Once biliary colic occurs, patients are at risk of:
● Acute cholecystitis
● Pus in gallbladder (empyema)
● Gangrene or perforation
● Stones entering bile duct → jaundice
● Cholangitis (bile duct infection)
● Pancreatitis (life-threatening)
After symptoms start, complication risk is 4–8% per year, making surgery mandatory.
Do Diabetics Need Preventive Gallbladder
Surgery?
No. This is a myth.
Scientific data clearly shows:
● Diabetics are not at higher risk of gallstone symptoms
● Diabetics are not at higher risk of gallstone complications
Indications for surgery in diabetics are exactly the same as the general
population. Only poorly controlled diabetes increases risk after a complication
develops — not before.
Can Gallstones Be Dissolved With Medicines?
No. This is another myth.
There is no proven medication in:
● Allopathy
● Ayurveda
● Homeopathy
Earlier attempts (like ursodeoxycholic acid or chemical solvents) failed because:
● Gallstones recur after stopping medication
● The gallbladder itself is diseased
A poorly functioning gallbladder (seen on tests like HIDA scan) will continue to form
stones.
“There is no role for stone-dissolving medicines.”
When Is Surgery Required?
Surgery is mandatory when:
● There is even one episode of biliary colic
● Symptoms recur
● Complications develop
Surgery is not required when:
● Gallstones are asymptomatic
● No typical gallstone pain is present
Special Situations Where Surgery May Be
Offered Even Without Symptoms
Surgery may be considered in selected asymptomatic patients, including:
Young patients (<30 years)
Lifetime risk of developing symptoms is higher.
Young women planning pregnancy
Hormonal changes worsen gallbladder function during pregnancy.
Patients undergoing other abdominal surgery
If already undergoing laparoscopy for:
● Hernia
● Cancer
● Gynecological surgery
Gallbladder removal may be done simultaneously.
Patient choice (Indian healthcare model)
In India, since patients often self-pay and gallbladder surgery is:
● Safe
● Low-risk
● Short hospital stay
Some patients may electively choose surgery after understanding risks and benefits.
Safety of Gallbladder Surgery
Laparoscopic cholecystectomy:
● Is one of the safest abdominal surgeries
● Usually needs 1–2 days of hospital stay
● Risk of bile duct injury is <1 in 500
Final Takeaway
● Gallstones are common
● Size and number do not matter
● Only biliary colic is a true gallstone symptom
● Asymptomatic stones usually need no surgery
● Once pain occurs, surgery is essential
● Patient education and proper decision-making are key
