Most gallstones never cause problems and need no treatment. When they do cause symptoms, keyhole removal of the gallbladder is the standard treatment. Here is how doctors decide, and what each option involves.
The answer depends mainly on whether your gallstones cause symptoms, and where they are.
No symptoms: gallstones found by chance in a normal gallbladder usually do not need treatment unless symptoms develop.
Symptoms: if gallstones cause attacks of pain, inflammation or other complications, keyhole removal of the gallbladder is offered.
For gallstones that cause no symptoms. No treatment is needed unless symptoms start, and most people with silent gallstones never develop them.
The standard treatment for gallstones that cause symptoms. It removes the source of the stones. Read about gallbladder removal surgery.
Pain with fever may be cholecystitis, treated in hospital with early keyhole surgery, ideally within a week. Gallstone pancreatitis also needs hospital care.
Stones in the bile duct are cleared, either during keyhole surgery or by ERCP (an endoscopic procedure) before or at the time of surgery, and the gallbladder is removed. Dr Kan performs both ERCP and keyhole surgery.
Medicines. Ursodeoxycholic acid can dissolve some small cholesterol stones in a working gallbladder, but treatment takes months, does not work for most stones, and stones often return after stopping. It is rarely a good alternative to surgery.
Cleanses and “flushes”. There is no good evidence that gallbladder flushes, cleanses or herbal remedies remove gallstones.
Removing only the stones. Stones in the bile duct can be removed without surgery by ERCP. For stones in the gallbladder itself, removing the stones but leaving the gallbladder is not standard practice, because new stones tend to form.
For keyhole gallbladder removal, the Ministry of Health fee benchmark for the surgeon’s fee is S$6,540 to S$9,156 including GST for uncomplicated surgery, with hospital and anaesthetist charges separate. MediSave and Integrated Shield Plans can be used where applicable. See the full cost breakdown.
Common questions about treating gallstones.
No. Gallstones found by chance in a normal gallbladder, without symptoms, usually do not need treatment unless symptoms develop.
Stones in the bile duct can be removed by ERCP, an endoscopic procedure, which Dr Kan performs. For stones in the gallbladder, removing the gallbladder is the standard treatment, because new stones tend to form if it is left behind.
Medicines such as ursodeoxycholic acid can dissolve some small cholesterol stones, but this takes months, does not work for most stones, and stones often come back after stopping. It is rarely used.
There is no good evidence that cleanses, flushes or herbal remedies remove gallstones. Some can cause diarrhoea that is mistaken for passed stones.
Until your gallstones are treated, avoid foods and drinks that trigger your symptoms, which for many people are large or fatty meals. Diet does not dissolve existing stones.
See a doctor if you have had an attack of upper belly pain lasting 30 minutes or more, and go to the emergency department if you have pain with fever, yellow skin or eyes, or pain lasting more than a few hours.
Bring your scan report to a consultation with Dr Kan Yuk Man, senior consultant surgeon, at Mount Elizabeth Orchard or Farrer Park Hospital.
Disclaimer: This article is for general information only and is not a substitute for medical advice. Please consult a qualified doctor for advice specific to your situation.
Clinical guidance based on NICE guideline CG188 (Gallstone disease).
