Treatment for gallstones depends on whether they are causing symptoms or complications. Gallstones that do not cause symptoms often require no treatment. When symptoms do occur, treatment usually involves removing the gallbladder and the stones it contains through keyhole surgery, known as laparoscopic cholecystectomy, rather than removing individual stones from within the gallbladder.

Gallstones can develop when the balance of cholesterol, bile salts and bile pigments changes. They become more common with age and are also associated with pregnancy, obesity, diabetes, rapid weight loss, certain blood disorders and inflammatory bowel disease.

Typical symptoms include pain in the right upper abdomen, which may spread to the back or shoulder blade, as well as nausea and discomfort after eating rich or fatty meals. Some patients also experience bloating or indigestion, although these symptoms can be caused by other conditions, including acid reflux.

A gallstone that temporarily blocks the outlet of the gallbladder can cause biliary colic. This usually presents as sharp upper abdominal pain that may last from several minutes to a few hours and can occur repeatedly.

If the gallbladder becomes inflamed, this is known as acute cholecystitis. It usually causes more persistent pain, often lasting longer than 24 hours, together with fever and a general feeling of being unwell. Hospital admission, antibiotics and early laparoscopic gallbladder surgery may be required.

Gallstones can also pass into the bile duct and cause further complications. A blocked bile duct may lead to jaundice, with yellowing of the skin and eyes, dark urine and pale stools. Fever accompanied by jaundice and abdominal pain may indicate cholangitis, which is a medical emergency. Small gallstones or biliary sludge can also obstruct the pancreatic duct and cause acute pancreatitis.

An ultrasound scan is usually the first investigation used when gallstones are suspected. Blood tests may also be carried out to assess liver function and look for signs of inflammation. Further investigations, such as MRCP, endoscopic ultrasound or CT, may be needed if bile duct stones or other complications are suspected.

Gallstones that are not causing symptoms often do not need treatment. Symptomatic gallstones are generally treated with laparoscopic cholecystectomy, a keyhole procedure that removes the gallbladder together with the stones inside it.

Rich or fatty meals can trigger symptoms in some patients. Eating a balanced diet, avoiding very fatty foods and maintaining a healthy weight may help reduce attacks while awaiting definitive treatment. Very rapid weight loss should be avoided unless it is medically supervised.

Laparoscopic cholecystectomy is performed under general anaesthetic through several small incisions. Compared with open surgery, it usually allows a quicker recovery, less scarring and a shorter hospital stay. In some cases, however, an open operation may be required if the procedure cannot be completed safely using keyhole surgery.