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decision pointShould I have surgery to treat gallstone attacks?

Surgery to remove the gallbladder usually prevents future gallstone attacks. The decision to have surgery depends largely on how often and how intense your gallstone attacks are and your ability to tolerate them. Consider the following when making your decision:

  • The main reason to treat gallstones is to prevent painful attacks and possible complications, including inflammation and infection of the gallbladder (acute cholecystitis) and inflammation of the pancreas (pancreatitis). If you feel comfortable managing mild and infrequent gallstone attacks and your health professional believes that you are not likely to have serious complications, you may choose not to have surgery.
  • Most medical experts recommend surgery if you have had repeated attacks of gallstones. If you have had one attack of gallstone pain, you may want to wait to see whether you have more.

What are gallstones?

Gallstones develop when cholesterol and other substances in the bile form crystals that become hard stones in the gallbladder. The stones may form because of too much cholesterol in the bile or because the gallbladder does not empty properly.

Gallstones may block the common bile duct.

Most gallstones do not cause symptoms. In people who do have symptoms, the most common complaint is pain of varying intensity in the upper right area (quadrant) of the abdomen. Nausea and vomiting also may develop along with the pain. If gallstones block the common bile duct, you may develop jaundice, dark urine, and light-colored stools.

How are gallstones treated?

Gallstones that cause symptoms are treated mainly with surgery to remove the gallbladder. Symptoms usually do not return after the gallbladder has been removed.

Two types of surgery may be done, one using a large incision (open cholecystectomy) and the other involving several small incisions (laparoscopic cholecystectomy). Laparoscopic surgery is generally preferred because it causes less pain after the operation and people can return to work and other activities more quickly than with open surgery.1, 2

In rare cases, doctors may try nonsurgical methods to remove gallstones. Bile acids are sometimes used to dissolve gallstones. They may be used alone or after lithotripsy, which breaks up small, noncalcified gallstones with shock waves that are focused by ultrasound.

For some people with stones in the common bile duct, a special type of endoscopic retrograde cholangiopancreatogram (ERCP) called endoscopic sphincterotomy may be used to remove gallstones that block the common bile duct. The doctor places an endoscope down the throat to the small intestine. The doctor then uses another procedure to widen the opening between the common bile duct and the small intestine and takes the stones out using a small basket. After ERCP, surgery to remove the gallbladder is often the next step.

However, endoscopic sphincterotomy may not prevent the need for gallbladder removal. One study found that symptoms returned within 2 years in 47% of people who had only sphincterotomy, compared with 2% who had immediate gallbladder removal. Of those people in the study who had recurrent symptoms, 81% eventually needed gallbladder removal (cholecystectomy).3

Overall, gallstones return within 5 years after nonsurgical treatment in 30% to 50% of people.1

What are the risks of not having the gallbladder removed?

There is little risk in not having surgery if you have only one bout of mild symptoms. However, if you have more than one episode of pain, you are likely to have more symptoms in the future.

The risks of not treating gallstones may include:

  • Unpredictable bouts of gallstone pain (biliary colic).
  • Episodes of inflammation or infection of the gallbladder, bile ducts, or pancreas.
  • Jaundice and other symptoms caused by blockage of the common bile duct.
  • An abnormal connection (fistula) between the gallbladder and the bowel. This is rare.

If you need more information, see the topic Gallstones.

Your choices are:

  • Have surgery to remove the gallbladder.
  • Wait and see whether you have another bout of gallbladder symptoms.

The decision about whether to have surgery to treat gallstones takes into account your personal feelings and the medical facts.

Deciding about surgery to treat gallstones
Reasons to have surgery Reasons not to have surgery
  • You are having repeated attacks of gallbladder symptoms.
  • The pain from the attacks is severe.
  • You have developed complications, such as inflammation of the gallbladder or the pancreas.
  • You have an impaired immune system.
  • Surgery to remove the gallbladder is safe and widely done.

Are there other reasons that you might want to have surgery to treat gallstones?

  • You have had only one gallbladder attack.
  • The pain is mild.
  • You have no complications from gallstones.
  • Surgery carries a small degree of risk, such as injury to the common bile duct or small intestine; you also could have diarrhea and other symptoms of postcholecystectomy syndrome.

Are there other reasons that you might not want to have surgery to treat gallstones?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having surgery to treat gallstones. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

1. I have had several attacks of pain from gallstones. Yes No Unsure
2. The pain was mild and tolerable. Yes No Unsure
3. If I am a candidate for nonsurgical treatments, I want to try them to see if they stop the gallbladder attacks. Yes No Unsure
4. I have tried nonsurgical treatments, and they did not stop the pain. Yes No Unsure
5. I have started to develop complications from the gallbladder attacks. Yes No Unsure
6. I have an impaired immune system. Yes No NA*

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have surgery or not to have surgery.

Check the box below that represents your overall impression about your decision.

Leaning toward having surgery

 

Leaning toward NOT having surgery

         

Citations

  1. Glasgow RE, Mulvihill SJ (2006). Treatment of gallstone disease. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 1, pp. 1419–1442. Philadelphia: Saunders Elsevier.

  2. Zacks SL, et al. (2002). A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. American Journal of Gastroenterology, 97(2): 334–340.

  3. Boerma D, et al. (2002). Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: A randomised trial. Lancet, 360(9335): 761–765.

Author Marianne Flagg
Associate Editor Tracy Landauer
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Brent Shoji, MD - General Surgery
Last Updated July 22, 2009

WebMD Medical Reference from Healthwise

Last Updated: July 22, 2009
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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