Gallstones and Laparoscopic Cholecystectomy
Gallstones and the Gallbladder
The gallbladder is a small pear-shaped organ that sits under the liver and stores bile that the liver produces. When the stomach encounters food containing any fat, it releases a hormone called cholecystokinin that stimulates the gallbladder to contract. This releases concentrated bile into the small intestine, where it helps digest and absorb fats and fat-soluble vitamins (A, D, E, and K).
The liver produces up to 1 litre of bile every day and the average gallbladder stores only 50 ml (5% of the daily bile produced). Most people therefore don't notice any difference if the gallbladder is removed. Approximately 15% of patients experience a change in bowel habit or abdominal symptoms in the short term. This is likely due to sudden change in the microenvironment of the bowel and symptoms resolve for the vast majority of patients within three months of surgery.
What are gallstones?
Gallstones are hardened deposits that form in the gallbladder. Gallstones develop when substances in bile, particularly cholesterol, become concentrated and crystallise.
Who gets gallstones?
Gallstones are extremely common, affecting approximately 6% of the global population and up to 15% of adults in the UK.
Gallstones are more common in some patient groups (women, people over 40 years of age and those with a family history of gallstones), but they can occur in anyone (including young male triathletes). Dietary factors may contribute, but are by no means solely responsible for stones occurring.
Potential complications of gallstones
If left untreated, gallstones can lead to more serious complications, including acute cholecystitis (inflammation of the gallbladder) or infection within the gallbladder (empyema).
For most patients with symptomatic gallstones, the gallstones stay within the gallbladder. In 10-15% of patients the stones move from the gallbladder to the main bile duct from the liver and this can cause jaundice, infection within the liver (cholangitis) or inflammation of the pancreas (pancreatitis). Management of these 'ductal stones' requires specialist treatment with either surgery or advanced endoscopy (please see ERCP booklet for further information if needed).
Treatment options
Surgery to remove the gallbladder is widely recognised as the gold-standard treatment for symptomatic gallstones. No medication has been shown to effectively 'dissolve' gallstones. Treatment with medications such as ursodeoxycholic acid has been trialled, but this has generally been reserved for patients who are not fit for surgery and the evidence of any benefit is limited.
Why does removing the gallbladder help?
The gallbladder stores and concentrates bile. Concentrated bile that is stagnant within the gallbladder is much more prone to precipitating stones compared to bile within the liver that moves through into the bowel as soon as it is produced.
Laparoscopic Cholecystectomy
Laparoscopic cholecystectomy simply means 'keyhole removal of the gallbladder'. The surgery usually takes under 60 minutes and is routinely performed as a day case procedure (i.e. with discharge home from hospital on the day of surgery or the following morning).
The surgery is performed under general anaesthesia and involves four small wounds (5-12 mm) in the abdomen to allow positioning of keyhole ports. The liver and gallbladder is inspected with a camera (laparoscopy); the gallbladder is then carefully disconnected from the main bile duct, dissected off the liver and removed in a bag via one of the larger keyhole ports. Skin incisions are closed with dissolvable sutures and these wounds tend to heal very well.
Risks of surgery and possible complications
While laparoscopic cholecystectomy is generally very safe, any surgery carries the risk of possible complications.
Common risks (affecting 1-5% of patients):
- Shoulder pain from residual gas within the abdomen (this resolves within 24-48 hours)
- Nausea and temporary loss of appetite
- Minor bleeding or bruising at wound sites
- Temporary change in bowel habit (e.g. loose stools), particularly after fatty foods
Uncommon risks (affecting less than 1% of patients):
- Conversion to open surgery (or deferred definitive surgery). This is very occasionally necessary (1%) for safety if the anatomy is unclear or keyhole surgery is not possible for other reasons (e.g. extensive adhesions from previous surgery).
- Bile leak (less than 1%): Usually resolves spontaneously or with simple drainage, but can require a further procedure (ERCP) if it doesn't settle
- Infection. Wound infections or chest infections are an inherent risk of all surgical operations. Keyhole surgery, combined with effective pain relief and early mobilisation minimise these risks.
- Blood clots (deep venous thrombosis or pulmonary embolism). The risk of blood clots is also minimised with keyhole surgery and early mobilisation. Patients staying overnight in hospital will be given a medication to reduce this risk further. Some medications such as HRT or the oral contraceptive pill can slightly increase the risk of blood clots -- stopping these medications temporarily is not usually necessary, but this will be discussed in detail before any surgery is planned.
Rare but serious complications (affecting less than 0.5% of patients):
- Bile duct injury (0.32-0.52%): This is a rare, but serious, potential complication of gallbladder surgery and often requires additional surgery to repair. If the gallbladder and liver anatomy is not clear, open surgery or a deferred definitive operation may be considered to further reduce the risk of bile duct injury occurring.
- Bowel injury (less than 0.3%): Usually recognised and repaired during surgery
- Bleeding requiring blood transfusion (less than 0.5%)
- Retained stones in bile duct: May require additional procedures such as ERCP
Long-term effects:
Most patients experience no long-term problems after surgery. A small percentage (5-15%) may develop post-cholecystectomy syndrome, which can include change in bowel habit (loose stools or increased frequency of bowel motions), or difficulty digesting very fatty meals. If these symptoms do occur, they usually improve over time.
Recovery and Aftercare
Laparoscopic cholecystectomy is usually performed at Shawfair Park Hospital, with admission in the afternoon and discharge home after review on the morning after surgery.
After waking up from surgery, your consultant anaesthetist will see you to ensure you are comfortable and prescribe appropriate pain killers to take home. The aim here is to be fully mobile and breathing normally. This usually involves a combination of pain killers for the first 2-3 days, followed by regular paracetamol for the remainder of the first week after surgery.
Most patients are up and about, eating normally and fit for short walks within 24 hours of surgery.
Activity can gradually increase from then on. I recommend to avoid driving for a minimum of one week (until you can safely perform an emergency stop) and to call your insurance company to update that you have had an operation, but have been advised you are ready to drive again.
Most patients should take two weeks off work (even if work is desk-based or from home). This is to allow sufficient recovery not just from the surgery, but from the (often considerable) symptoms that have led to surgery in the first place.
I arrange to see all patients in clinic within 2 weeks after surgery and can provide any letters or fitness to work certificates that might be needed.
Summary
Gallstones are a common condition that can cause significant symptoms and serious complications if left untreated. Laparoscopic cholecystectomy is a safe, effective treatment that offers excellent outcomes, but does carry some risks. The procedure provides permanent cure of gallstone disease with faster recovery and fewer complications compared to open surgery.
Most patients make a full recovery within 2-4 weeks and can return to all normal activities.
Chris Johnston PhD FRCS FRCP
Consultant Transplant & General Surgeon
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References
1. Wang X, et al. Global Epidemiology of Gallstones in the 21st Century. Gastroenterology. 2024;166(4):860-884.
2. Jones MW, et al. Gallstones (Cholelithiasis). StatPearls Publishing. 2024.
3. Roy DK, et al. A Systematic Review and Meta-Analysis of the Outcomes of Laparoscopic vs Open Cholecystectomy. World J Surg. 2024;48(2):347-359.
4. Pucher PH, et al. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy. Surg Endosc. 2018;32(5):2175-2183.
5. Zackria R, et al. Postcholecystectomy Syndrome. StatPearls Publishing. 2023.
6. Gether IM, et al. New Avenues in the Regulation of Gallbladder Motility and Role in Digestive Health. J Clin Endocrinol Metab. 2019;104(7):2463-2479.
7. Vincenzi P, et al. Bile Duct Injuries after Cholecystectomy: An Individual Patient Data Systematic Review. J Clin Med. 2024;13(16):4738.
8. Abdu SM, et al. Prevalence of gallstone disease in Africa: a systematic review and meta-analysis. BMJ Open Gastroenterol. 2025;12(1):e001441.