Treatment of gallstones and gallbladder disease

Silent gallstones require no treatment and if found by chance would be managed expectantly. When complications occur, such as recurrent biliary colic, cholecystitis or obstructive jaundice, the treatment of choice is removal of the gallbladder (cholecystectomy).

In cases that are not suitable for surgery, other techniques can be used. The stones may be dissolved by specific medication, although this method can be slow and ineffective in some cases. The stones can be broken up using high-energy shock waves (lithotripsy) to shatter the stones into tiny particles, which then should pass out in the bile. This method does carry a high risk of causing recurring biliary colic if the residual particles produced by the procedure are still large enough to irritate the bile duct as they pass.

Most episodes of chronic cholecystitis can be managed at home with suitable painkillers and treatment for nausea and vomiting.

Symptoms that persist for more than 24 hours with severe pain and fever indicate probable acute cholecystitis, which may need hospital admission for supportive treatment, analgesia and administration of an antibiotic. Complications such as perforation of the gallbladder or the development of persistent obstructive jaundice require emergency surgical intervention.

In chronic cholecystitis or following a significant attack of acute cholecystitis, definitive treatment to may be indicated when the acute phase has settled. The method of choice is removal of the gallbladder with its contents (cholecystectomy).