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What is

  • The gallbladder is a pear-shaped organ that rests beneath the right side of the liver.
  • The purpose of gallbladder is to store and concentrate bile produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through narrow tubular channel (bile duct) into the small intestine (called common bile duct or CBD).

What are Gallstones?

Gallbladder stones or gallstones are crystalline masses formed abnormally in the gall bladder or bile ducts from bile pigments, cholesterol, and calcium salts. Gallstones can cause severe pain and blockage of the bile duct. When the wall of the gallbladder is diseased then it produces the stone and polyps etc.

The two main types of gallstones are:

Cholesterolstones: Usually yellow-green in color, approximately 80% of gallstones are cholesterol stones.

Pigment stones: These stones are smaller and darker and are made up of bilirubin.

Who is at risk for gallstones?

  • Women are more prone than men
  • People in their 30's and 40's
  • Overweight men and women
  • People with rapid/ sudden weight loss
  • Pregnant women, women on hormone therapy and women who use birth control pills for a prolonged period
Symptoms &


Symptoms of gallstones are severe abdominal pain often called as gallstone 'attack' (colic) because they occur suddenly. Gallstone attacks often follow fatty meals, and they may occur during the night. A typical attack can cause the following:

  • Severe pain in the right upper abdomen that increases rapidly and lasts from few minutes to several hours
  • Pain in the back between the shoulder blades
  • Pain under the right shoulder
  • Nausea or vomiting

Other insignificant symptoms of gallstones include:

  • Abdominal bloating (gas formation)
  • Recurring intolerance to fatty foods
  • Belching
  • Indigestion

Many patients with gallstones have no symptoms, these patients are said to be asymptomatic and these stones are called ‘Silent stones’.



Complications of gallstones may include:

  • Recurrent severe abdominal pain or vomiting.
  • Jaundice due to blockage of the common bile duct due to stones.
  • Acute pancreatitis (swelling of pancreas) which can have catastrophic sequel of multi-organ failure and other serious complications. It may be fatal if severe.
  • Pus formation in the gallbladder (Empyema).
  • Gangrene and perforation of the gallbladder.
  • Cholangitis (life threatening infection of biliary system).
  • Associated with Cancer of gallbladder in the long term.
Gall bladder Polyp

Gall bladder polyp include all mucosal projections into the gall bladder lumen and include cholesterol polyps, adenomyomas, inflammatory polyps, adenomas and other miscellaneous polyps. Most of this ultimately leads to formation of stones or in malignancy inlarge polyps.

Biliary Pancreatitis

Bile duct and pancreatic duct open in intestine through common opening. Gallstones, produced in the gallbladder, can block the bile duct, stopping pancreatic enzymes from traveling to the small intestine and forcing them back into the pancreas. The enzymes then begin to irritate the cells of the pancreas, causing the inflammation associated with pancreatitis. This is very serious clinical condition with severe sufferings. In many severe cases it may be fatal as well.

Gallbladder stones and association with Gallbladder cancer

Association of gall bladder stones with gall bladder cancer is well established. It is a well-documented medical fact that more than 85% gallbladder cancers have shown to have gall bladder stones as well.

The female gender, multiple child births and obesity are also some of the factors that are associated with higher risk of developing gall bladder cancer. The evidences point towards the environmental and genetic factors playing an important role in development for gallbladder cancer. The basis for development of cancer in the setting of gallbladder stones likely occurs through chronic irritation and local production of carcinogens. The larger the gallstones (more than 2-3 cm in diameter), the greater the association with gallbladder cancer. Stone more than 3 cm is considered as pre-malignant condition.


Symptomatic Management:

  • Treatment of symptoms of pain with injectable or oral painkillers.
  • No medical therapy is available for gallstones as such which can cure the disease. Injectable or oral antibiotics and supportive medications are available for treating the infection and overcoming the acute attack.
  • Gallbladder removal is one of the most commonly performed laparoscopic surgical procedures.
  • Gallbladder removal surgery with minimum invasive techniques is also termed as “Laparoscopic Cholecystectomy” or “Lap Chole”.

Surgery: Surgery to remove the gallbladder (cholecystectomy) is the only way to cure gallstones. This can be done by conventional (open) method or a well-established endoscopic (laparoscopic) method which is now the 'Gold Standard'.

The surgery is called Laparoscopic Cholecystectomy (Lap. Chole). For this operation, the surgeon makes few tiny punctures in the abdomen and inserts surgical instruments and a miniature telescope with amounted video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts and vessels. The gallbladder is then removed through one of the small incisions. Recovery usually occurs within few hours in most of the cases in the hospital, followed by few days of rest at home. As there is no damage to the muscle (muscles are not cut) during laparoscopic surgery, patients have less pain and negligible wound complications.

If the surgeon finds any difficulty in the laparoscopic procedure, the operating team may decide to switch over to open surgery. It is called open surgery because the surgeon has to make a 5 to 8 inch incision in the abdomen to remove the gallbladder. Open surgery has faded into the background with the laparoscopic technique providing significant advantages and ease for the patient.

What if a stone slips into the Common Bile Duct (CBD)?

Slippage of the stone(s) in CBD may cause pain or jaundice or both. This situation requires an endoscopy (ERCP) for removing the stone(s). This should preferably be done before surgery. However it may also be done after the operation.

How do we confirm if a stone is in the CBD?

Sometimes a stone in the CBD may not show on ultrasound; however patient may have symptoms which are indicative of the same. In this event, the patient requires magnetic resonance cholangiopancreatography (MRCP - an MRI scan) which shows the presence of stones in the common bile duct.

What is ERCP?

The surgeon may use endoscopy through mouth for removing CBD stones before gallbladder surgery. Once the endoscope is in the small intestine, the surgeon locates the opening of the bile duct. An instrument on the endoscope is used to cut the duct, and the stone is captured in a tiny basket and removed with the endoscope. This two-step procedure is called ERCP andEPT.

Non-surgical treatment

Non-surgical approaches are used only in special situations such as when a patient's condition is not fit for anaesthesia and surgery. This does not cure the patients as it only provides symptomatic relief.

Frequently Asked Questions

Pre surgery instructions:
  • Some preoperative investigations like blood tests, X-ray or ECG and ultrasound of the gallbladder are required before surgery.
  • Follow your surgeon instructions for any prescribed medications.
  • You may be asked to stop taking aspirin, , warfarin and any other blood thinners which are mostly used in cardiac or neurological cases.
  • The patient is kept under observation for few hours and then shifted to the room.
  • Patient is allowed to drink oral liquids on the same day of surgery.
  • The patient is allowed to move on its own as soon as possible after the surgery.
  • Generally the patient is discharged on the same or next day of the surgery depending on the clinical condition.
  • Waterproof dressings are applied on the port sites and the patient may bathe when comfortable.
  • The patient is advised to visit again after 5 days when the dressings are removed. On discharge, a discharge summary with the advised medication is handed over to the patient along with the date of the first follow up appointment.
  • Round the clock helpline is available for any query or any other emergency.
  • Diet after surgery.
      • The patient is generally allowed to have sips of water immediately after the operation and liquids on day of operation. The liquids may include water/ clear soups/ tea/ coffee/ salted lassi as advised by the dieticians.
      • Next day onwards, normal diet is given and there are no specific restrictions in diet.
  • Exercise/ Movement
      • As soon as the patient is out of anesthesia and is shifted to the room, patient is up and about and can start moving on his/her own and attend to toilet needs. In fact movements are encouraged in most patients because this causes a dramatic reduction in pain and increase the sense of wellbeing. There are no restrictions whatsoever for the physical movement. The patient is allowed to walk as soon as he/she recovers from sleep. There is no restriction on climbing stairs, lifting weight.
  • The patient can resume his/her daily routine/ activities as he/she feels comfortable as there are no specific restrictions.
  • Medication chart is provided to the patient to ensure proper compliance of prescribed medications.Ensure compliance of pain and other medications prescribed by your doctor.
  • Regular follow up is advised.

Frequently Asked Question

Fortunately, the gallbladder is an organ that people can live without. Losing it doesn’t require any change in diet. Even when the gallbladder is removed, bile production remains unaffected as it is produced in the liver. The bile by liver helps in digestion of food as before.

The gall bladder is a small bag, roughly the shape and size of a pear that sits underneath the liver, on the right side of the abdomen.

Its main purpose is to store and concentrate bile produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through common bile ducts (CBD) into the small intestine.

Gallstones are pieces of solid material that form in the gallbladder. These stones develop because cholesterol and pigments in bile sometimes form hard particles.

  • Women between the ages of 20 and 60 years are more likely to form gallstones than men.
  • Those over 60 (men and women) are at a higher risk of developing gallstones.
  • People who are overweight are more likely to form gallstones.
  • Excess estrogen from numerous pregnancies, hormone replacement therapy, or birth control pills may increase cholesterol levels in bile, slow down gallbladder emptying, and lead to gallstones.
  • People who have biliary infections can develop gallstones.
  • Individuals with hereditary blood disorders such as sickle cell anaemia are more likely to form pigment stones.
  • Going on a diet and certain cholesterol-reducing drugs can also increase the risk of gallstone formation.

Cholecystitis is defined as inflammation of the gall bladder. Most commonly this happens when the flow of bile is stopped or interrupted due to stone (90%) or if infection of biliary tract occurs.

The usual symptomsof cholecystitis are:

  • Severe abdominal pain
  • Fever
  • Malaise
  • Nausea
  • Vomiting
  • The attack may follow a large fatty meal.
  • Blood tests
  • Complete blood count
  • Liver function test
  • Coagulation profile
  • Abdominal ultrasound
  • Cholescintigraphy (HIDA scan)
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Magnetic resonance cholangiopancreatography (MRCP)

The symptomatic stones and diseased gallbladder should be removed by a surgical procedure called Cholecystectomy.

No, the gall bladder is removed with the stones, otherwise the stones may form again.

Fortunately, the gallbladder is an organ that people can live without. Losing it won’t even require a change in diet. Once the gallbladder is removed, bile flows out of the liver through the hepatic ducts into the common bile duct and goes directly into the small intestine, instead of being stored in the gallbladder.

  • Open Cholecystectomy: The gallbladder is removed through an incision on the right side under the rib cage.Open surgery has faded into the background with the laparoscopic technique providing significant advantages and ease for the patient.
  • Laparoscopic Cholecystectomy: The gallbladder is removed with long narrow instruments placed through small incisions in the abdomen.

Slippage of the stone(s) in CBD may cause pain or jaundice or both. This situation requires an endoscopy (ERCP) for removing the stone(s). This should preferably be done before surgery. However it may also be done after the operation

Generally, hospital stays are between one to two days.

In general, plan to take about one week off from work.

Mostly the procedure is covered under most medical insurance plans. Please confirm in your policy documents