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Gallstones are hard, pebble-like formations that develop in the gallbladder, a small organ located below the liver. The gallbladder’s primary role is to store and release bile, a digestive fluid produced by the liver that helps break down fats. When the balance of substances in bile—like cholesterol, bile salts, and waste products—is disrupted, gallstones can form.
These stones can range in size, from as tiny as a grain of sand to as large as a golf ball. While some people with gallstones experience no symptoms, others may face severe abdominal pain, nausea, or digestive issues when gallstones block the bile ducts.
The gall bladder is a small organ which is situated below your liver on the right upper part of your abdomen. It stores the bile that is produced from your liver which helps in the digestion of food, but it’s an organ that you can live without.
It is prone to develop stones (gall stones) due to the high concentration of bile in the gallbladder which then crystallises into deposits and will subsequently form stones.
The presence of gallstones alone doesn’t automatically mean they need to be removed. The crucial factor that dictates whether gallstone removal is necessary is the presence and nature of symptoms.
Here’s how symptoms guide the decision of removing gallstones:
Common symptoms:
Warning signs:
Rare cases like very large gallbladder polyps or a “porcelain gallbladder” might warrant proactive removal due to elevated risks.
Key Takeaway: The decision for gallstone removal is not about the mere existence of the stones, but about their impact on your health and quality of life. If gallstones are causing bothersome or dangerous symptoms, intervention is usually the safer and more effective path forward.
Gallstones develop when the chemical balance of bile is disrupted. Causes that contribute to gallstones include:
Gallstones themselves don’t always need to be removed if they’re not causing symptoms. However, if they lead to complications or symptoms such as pain, infection, or blockages, treatment becomes necessary. In such cases, the removal of the gallbladder (cholecystectomy) is often recommended to prevent future issues.
Below, we’ll break down the main scenarios in which surgery is usually needed, along with symptoms, complications, and what to expect.
| Symptoms | When is Surgery Necessary | |
|---|---|---|
|
Symptomatic Gallstones |
Gallstones (solid deposits formed in the gallbladder) can remain silent for years. However, when they cause symptoms, such as sharp pain in the upper right abdomen, nausea, or vomiting, it’s referred to as symptomatic gallstones or biliary colic. |
If symptoms persist or worsen, surgery may be recommended to prevent recurring episodes of pain and the risk of more serious complications. A cholecystectomy removes the gallbladder altogether, eliminating the source of gallstone formation. |
|
Recurrent Biliary Colic |
Biliary colic causes sporadic, intense episodes of pain that can last for a few minutes to several hours. These episodes often occur after eating fatty meals and are caused by a gallstone blocking the flow of bile. |
If these painful episodes occur repeatedly, removing the gallbladder can offer relief. Surgery prevents further discomfort and lowers the risk of future complications, such as inflammation or infection. |
|
Acute Cholecystitis |
Acute cholecystitis is a painful inflammation of the gallbladder, often caused by a stone blocking the cystic duct. Symptoms include severe abdominal pain, fever, nausea, and tenderness in the upper right abdomen. |
Acute cholecystitis is a medical emergency. For most patients, surgery is required to treat the inflammation and prevent potentially serious complications like infection or gallbladder rupture. While antibiotics may be used initially to control infection, the definitive treatment is often a cholecystectomy, usually performed shortly after stabilisation. |
|
Gallstone Pancreatitis |
Gallstones can occasionally block the bile duct and pancreatic duct, triggering inflammation of the pancreas (pancreatitis). This condition causes severe abdominal pain, nausea, vomiting, and a rapid heartbeat. |
For gallstone-induced pancreatitis, surgery is commonly recommended once the inflammation subsides. Removing the gallbladder prevents future episodes and the potentially life-threatening risks associated with recurrent pancreatitis. |
|
Gallbladder Polyps |
Gallbladder polyps are growths on the inner lining of the gallbladder. These are often detected incidentally during imaging tests and are usually asymptomatic. |
While most gallbladder polyps are harmless, large polyps (over 1 cm) or those associated with symptoms may carry a higher risk of gallbladder cancer. Surgery is usually recommended for larger polyps or when there’s suspicion of malignancy. |
Gallstones can result in pain in the upper right or center of your stomach. You may experience gallbladder pain occasionally after eating certain foods, such as those high in fat. However, pain from gallstones can also occur at any point of time.
Without treatments such as gallstone removal, it can turn into more severe medical issues, including inflammation or infection of the gallbladder, bile duct or pancreas.
Stones lodged in the common bile duct can cause symptoms that are similar to those produced by stones that lodge in the gallbladder, but they may also cause:
Sharp, cramping, or dull pain under the ribs that may radiate to the right shoulder or back, particularly after eating fatty meals.
Triggered by greasy or heavy foods.
Feeling gassy or uncomfortably full after meals.
A sign of possible gallbladder infection.
Yellowing of the skin or eyes, which usually occurs if a gallstone blocks the bile duct.
These may be indications of bile flow disruption.
You may then need to undergo procedures such as minimally invasive gallbladder removal (cholecystectomy) or other medical treatments. When in doubt, consult your Gallstone Surgeon right away!
Lower your chances of complications, see your doctor early and discuss your best treatment options.
Keyhole Gallbladder Surgery
Gallstone removal is most commonly done by surgically removing the gallbladder. This is a procedure known as cholecystectomy. This is the standard treatment because it not only removes existing gallstones but also prevents new ones from forming in the future.
The surgeon typically uses laparoscopic (keyhole) surgery as this is associated with less pain, less scarring and a faster return to normal activities.
Gallstone removal using laparoscopic cholecystectomy is performed under general anaesthesia, ensuring you remain comfortable and pain-free throughout the procedure.
The surgeon makes several small incisions in the abdomen. Through one of these, a laparoscope — a thin tube equipped with a tiny camera — is inserted to provide a clear, magnified view of the gallbladder and surrounding structures on a monitor.
Specialised surgical instruments are then introduced through the other small incisions to carefully detach the gallbladder from its attachments. Once freed, the gallbladder is removed through one of the incisions.
Finally, the incisions are closed using sutures or surgical glue, resulting in minimal scarring. Most patients experience less postoperative pain and enjoy a faster recovery compared to open surgery.
Gallstone removal using open cholecystectomy is typically performed under general anaesthesia, ensuring you are completely comfortable and unaware during the procedure.
The surgeon makes a single larger incision (about 6–8 inches) in the upper right area of the abdomen, just below the rib cage. This allows direct access to the gallbladder and surrounding structures.
Through this opening, the surgeon carefully locates and detaches the gallbladder. Once the gallbladder has been taken out, the incision is closed with sutures or staples. Because this approach involves a larger opening, patients usually require a longer hospital stay and recovery time compared to laparoscopic surgery.
The procedure requires only small incisions, resulting in less postoperative pain and a quicker recovery compared to traditional open surgery.
Patients typically spend less time in the hospital after laparoscopic cholecystectomy, allowing for a faster return to daily activities.
The small incisions lead to smaller scars, making them less noticeable and cosmetically appealing.
The procedure involves smaller incisions, reduced tissue trauma, and a faster recovery compared to traditional open surgery, making the risk of complications and infections much lower.
At our clinic, we understand that affordability and transparency are key when it comes to your healthcare. Gallstone removal surgery, or cholecystectomy, is a common procedure we offer, and we’re committed to providing clear and comprehensive information to help you plan for your care.
Risks and Complications
Although laparoscopic cholecystectomy is generally considered safe, as with any surgical procedure, it carries some risks. Potential complications may include infection, bleeding, or injury to nearby organs or blood vessels. In rare cases, the laparoscopic approach may need to be converted to an open surgery if unexpected difficulties arise.
Following the surgery, patients are closely monitored in the recovery area before being discharged. Full recovery usually takes a few weeks, during which time patients are advised to take it easy and avoid strenuous activities. The surgical team will provide specific aftercare instructions, including wound care, pain management, and dietary guidelines.
Complications such as biliary colic, cholecystitis, pancreatitis, bile duct obstruction, cholangitis, gangrene of the gallbladder or even gallbladder cancer may occur.
Biliary Colic: Gallstones can block the flow of bile from the gallbladder, leading to episodes of intense pain known as biliary colic. These painful episodes can be triggered by fatty meals and may require medical intervention.
Cholecystitis: Gallstones may cause inflammation of the gallbladder, a condition known as cholecystitis. This can lead to persistent pain, fever, and potential complications, requiring urgent medical attention and often leading to gallbladder removal.
Pancreatitis: In some cases, gallstones can migrate from the gallbladder and block the pancreatic duct, causing inflammation of the pancreas (pancreatitis). Pancreatitis can be a severe and potentially life-threatening condition.
Bile Duct Obstruction: Large gallstones or multiple gallstones may obstruct the bile duct, leading to jaundice (yellowing of the skin and eyes), itching, and dark urine. Bile duct obstruction requires prompt medical evaluation and intervention.
Cholangitis: When the bile duct becomes infected due to blockage by gallstones, it can lead to a serious condition called cholangitis. Cholangitis requires immediate medical attention and often necessitates gallbladder removal.
Gangrene of the Gallbladder: If the gallbladder becomes severely inflamed and its blood supply is compromised, it may lead to gangrene, a condition where the gallbladder tissue dies. Gangrene of the gallbladder is a medical emergency requiring immediate surgical intervention.
Gallbladder Cancer: In rare cases, the long-term presence of gallstones may increase the risk of developing gallbladder cancer. Removal of the gallbladder before cancer develops is usually the recommended course of action.
It is essential to seek medical advice if you have gallstones or experience symptoms such as severe abdominal pain, fever, or jaundice. Your healthcare provider can evaluate your condition and recommend the appropriate treatment, which may involve gallstone removal or, in some cases, gallbladder surgery.
Gallstones are typically categorised into three main types based on their composition:
These are the most common type of gallstones, accounting for the majority of cases. They're typically yellowish in colour and composed mainly of cholesterol. Cholesterol gallstones form when bile contains excessive cholesterol, not enough bile salts, or when the gallbladder doesn’t empty efficiently.
Pigment stones are smaller and darker, often black or brown, these are also more common in our part of the world here in Singapore. They are made of bilirubin, a substance produced when the body breaks down red blood cells. These stones are more likely to occur in individuals with certain medical conditions, such as liver disease, hemolytic anaemia, or infections in the bile ducts.
As the name suggests, these gallstones are a mixture of cholesterol and pigments. They often develop in various shapes and sizes and may form alongside other types of gallstones.
It may be found incidentally during test for other problems or conditions and in these cases the gall stones are asymptomatic and causing no problems.
You may be experiencing the symptoms from them and the doctor will typically start off with a physical examination that includes checking your eyes and skin for any visible changes in colour.
Further tests such as Ultrasound, CT Scan, Gallbladder Radionuclide Scan, Blood Test, or an Endoscopic Retrograde Cholangiopancreatography (ERCP) can help detect the presence of any gallstones.
If unsure, consult an experienced Surgeon in Singapore like Dr Kan Yuk Man for a thorough examination!
Your doctor may recommend surgery if:
Gallstones themselves are not dangerous, and in fact, most patients that have gallstones, don’t experience any pain. Rather, pain occurs when the gallstones block the movement of bile from the gallbladder (Biliary Colic) and tends to happen after eating a fatty meal. When this happens, there maybe be severe pain which may resolve after a short period of time or it can be persistent, resulting in an admission to the hospital for strong pain killers.
It can cause inflammation and infection in the gallbladder. You will experience pain in the upper part of your stomach and fever. This is known as acute cholecystitis, which is dangerous and considered an emergency.
The stones can drop out the gall bladder into the duct that leads to the bowel and will cause a blockage to the flow of the bile. This can result in Jaundice or inflammation of the pancreas (Pancreatitis). Both of which are an emergency. Too much bilirubin in your body can cause jaundice, which is a yellowish tint in your eyes or on your skin. Your stools will become very pale and your urine will become very dark in colour.
In some cases, the infection can be so severe that the gall bladder become filled with pus (Gallbladder Emypema) or the lining of the gall bladder dies off and becomes necrotic. You will become extremely ill with this.
If you have no symptoms and it is found incidentally, then it is quite safe to leave the gall stones alone.
If you experience any of the above-mentioned symptoms, you should seek advice from Dr Kan right away. Delayed treatment can lead to complications such as:
Most patients with gallstone symptoms will need surgery. Surgery will involve the removal your entire gallbladder (cholecystectomy) rather than just removing the stones as they can re-occur if you do not remove the gall bladder leading to more problems.
Techniques to remove the gallbladder include:
Unsure if you’re suffering from gallstones? Consult Dr Kan immediately to ensure a peace of mind!
Removing gallstones usually means removing the gallbladder through laparoscopic surgery. It is considered a routine, minimally invasive procedure rather than a major open operation, with small incisions and faster recovery.
Yes—if gallstones cause pain, infections, or complications, removing the gallbladder is the most effective and permanent treatment. It prevents symptoms from coming back.
During surgery you won’t feel pain due to anaesthesia. Afterwards, most patients experience mild to moderate discomfort that typically improves within a few days.
There is no specific size that determines surgery. Treatment depends on symptoms and complications. Even small stones can trigger severe pain, while large stones may be riskier for blockage.
Non-surgical methods like medications exist, but they rarely work and are suitable only for very limited cases. Most symptomatic gallstones require surgery for lasting relief.
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