Gallstones are one of the most common surgical conditions in Australia, affecting approximately one in five adults at some point in their lives. While many people with gallstones experience no symptoms, those who do can suffer significantly from recurrent abdominal pain, nausea, and the risk of serious complications including acute infection and pancreatitis.

Laparoscopic cholecystectomy (keyhole removal of the gallbladder) is the standard and highly effective surgical treatment for symptomatic gallstones. It is a safe, well-established procedure with a rapid recovery and excellent long-term outcomes.

Gallbladder surgery is part of the general surgical services offered at Breast & Surgical Oncology at The Poche Centre, particularly by Dr Samriti Sood, whose general surgical training includes extensive experience in laparoscopic cholecystectomy. If you have been referred for gallbladder surgery or have been told you have gallstones and would like specialist advice, we welcome a consultation.

The Gallbladder and Its Function

The gallbladder is a small, pear-shaped organ tucked beneath the liver on the right side of the abdomen. Its primary function is to store and concentrate bile, a digestive fluid produced continuously by the liver. When you eat, particularly fatty foods, the gallbladder contracts and releases bile through the bile duct into the small intestine, where it helps break down dietary fats.

The gallbladder is a useful but non-essential organ. Life without a gallbladder is entirely normal, with bile flowing directly from the liver into the small intestine rather than being stored and concentrated in the gallbladder. Most people who have their gallbladder removed notice little or no change in their digestion over the long term.

What Are Gallstones?

Gallstones are solid particles that form within the gallbladder when the chemical composition of bile becomes imbalanced. They range in size from tiny grains of sand to large stones several centimetres across. A gallbladder may contain a single large stone, dozens of small ones, or anything in between.

There are two main types of gallstones. Cholesterol stones are the most common type in Australia, accounting for around 80% of all gallstones. They form when bile contains too much cholesterol relative to bile salts, causing cholesterol to crystallise and aggregate into stones. Pigment stones are smaller, darker stones made primarily of bilirubin and are more common in people with certain conditions including liver cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anaemia in which excess bilirubin is produced.

Who Is at Risk of Developing Gallstones?

Several factors are associated with an increased risk of gallstone formation. These include being female (women are twice as likely as men to develop gallstones), age over 40, obesity (particularly in women, where excess cholesterol in the bile is more common), pregnancy and hormonal factors (elevated oestrogen from pregnancy increases cholesterol secretion into bile), diabetes (associated with higher triglyceride levels which predispose to stone formation), rapid weight loss (which causes the liver to secrete excess cholesterol into bile during fat metabolism), a family history of gallstones, and certain cholesterol-lowering medications which can increase cholesterol secretion into bile.

Symptoms of Gallstones

Many people have gallstones and never know it. These are called "silent" gallstones and are often discovered incidentally during an ultrasound or CT scan performed for another reason. Silent gallstones generally do not require treatment.

When gallstones cause symptoms, the most characteristic presentation is biliary colic, a pattern of recurring episodes of pain in the upper right abdomen or, sometimes, the centre of the upper abdomen. The pain typically begins relatively suddenly, builds over several minutes to a peak, and can last from 30 minutes to several hours before gradually easing. It is often triggered by a fatty meal and may occur at night. Pain may radiate to the right shoulder blade or between the shoulder blades. Nausea and vomiting frequently accompany the pain.

Other symptoms that may be associated with gallstones include bloating and fullness after fatty meals, recurring intolerance of rich or fried foods, and mild indigestion.

It is important to note that gallstone symptoms can closely resemble those of other abdominal conditions including heart attack, appendicitis, peptic ulcer disease, pancreatitis, and reflux. An accurate diagnosis based on clinical assessment and appropriate imaging is essential before treatment decisions are made.

Diagnosis of Gallstones

Ultrasound is the most sensitive and specific test for gallstones and is the first-line imaging investigation. It is safe, painless, involves no radiation, and can reliably detect gallstones in most cases. It also provides information about the gallbladder wall thickness, the bile ducts, and the surrounding structures.

Blood tests are used to assess for signs of infection (elevated white cell count, CRP), bile duct obstruction (elevated bilirubin, alkaline phosphatase), liver function, and pancreatitis (elevated lipase).

CT scan provides additional detail about gallstone complications including acute cholecystitis, bile duct stones, and pancreatitis. It is not a first-line test for uncomplicated gallstones but is valuable in more complex presentations.

MRCP (magnetic resonance cholangiopancreatography) is a non-invasive imaging technique used to assess the bile ducts in detail, particularly when a stone in the common bile duct is suspected.

Complications of Gallstones

When gallstones cause complications, they often do so through obstruction of the bile duct outlets, leading to infection, inflammation, or damage to related structures.

Acute cholecystitis is inflammation of the gallbladder, almost always caused by a gallstone blocking the gallbladder outlet (the cystic duct). It presents as severe, persistent upper right abdominal pain, fever, nausea, and tenderness over the gallbladder. It requires prompt medical assessment and usually inpatient treatment with antibiotics, with cholecystectomy recommended during the same hospital admission or soon after.

Bile duct stones (choledocholithiasis) occur when a gallstone passes from the gallbladder into the common bile duct, causing obstruction. This can produce jaundice (yellowing of the skin and eyes), dark urine, pale stools, and severe pain, and may lead to cholangitis (infection of the bile duct) or pancreatitis if untreated. Bile duct stones are treated with ERCP (see below) to remove the stone from the duct, followed by cholecystectomy to prevent recurrence.

Cholangitis is a bacterial infection of the bile duct, typically resulting from obstruction by a stone. It is a potentially serious illness requiring urgent treatment with antibiotics and duct clearance.

Pancreatitis can develop when a gallstone migrates and blocks the pancreatic duct outlet, causing inflammation of the pancreas. Gallstone pancreatitis ranges from mild to life-threatening and requires hospitalisation.

If you experience severe, persistent abdominal pain, particularly with fever, jaundice, or vomiting, seek emergency medical assessment without delay.

When Is Surgery Recommended?

Surgery is recommended when gallstones are causing symptoms. Patients who have had one or more episodes of biliary colic are at significant risk of further and potentially more serious episodes, and cholecystectomy is generally advised to prevent complications. The timing of surgery depends on the acuity of the presentation and the patient's overall health.

For patients with uncomplicated symptomatic gallstones, cholecystectomy is typically performed as a planned (elective) procedure, often within weeks to months of diagnosis. For patients who present with acute cholecystitis, early cholecystectomy during the same admission (within 72 hours if possible) is associated with better outcomes and is now the recommended standard of care. For patients with bile duct stones, ERCP to clear the duct is performed first, followed by cholecystectomy.

Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the gold standard surgical treatment for symptomatic gallstone disease and is now the standard method for gallbladder removal worldwide. It is a minimally invasive procedure associated with significantly less pain, a faster recovery, and smaller scars compared to open surgery.

The procedure is performed under general anaesthetic. Four small incisions (each approximately 5 to 10 mm) are made in the abdomen. A laparoscope (a thin tube with a camera and light source) is inserted through one incision, and fine surgical instruments through the others. Carbon dioxide gas is used to inflate the abdominal cavity and create working space. The camera transmits magnified, high-definition images of the surgical field to a monitor, guiding the surgeon throughout the procedure.

The gallbladder is carefully separated from the liver and surrounding structures and its connections to the bile duct and blood vessels are identified, clipped, and divided. An X-ray of the bile duct (intraoperative cholangiogram) is taken to confirm the anatomy and exclude any stones that may have migrated into the common bile duct. If duct stones are identified, they can be removed laparoscopically during the same procedure or via ERCP after surgery. The gallbladder is removed through one of the port incisions. The incisions are closed with sutures.

The procedure typically takes 45 minutes to 90 minutes. Most patients are discharged the same day or the following morning.

When open surgery is required, laparoscopic cholecystectomy cannot always be completed safely. If the anatomy is unclear, significant adhesions are encountered, or if a complication occurs, conversion to open surgery (a larger abdominal incision) may be necessary. Your surgeon will explain this possibility before the operation. Conversion rates are low in experienced hands.

ERCP (Endoscopic Retrograde Cholangiopancreatography)

ERCP is a procedure used to remove stones from the common bile duct. It is performed by a specialist gastroenterologist using a flexible endoscope passed through the mouth, throat, and stomach into the small intestine to access the opening of the bile duct. The duct can be widened (sphincterotomy) and stones removed or a stent placed to relieve obstruction. ERCP is not a surgical procedure and is coordinated with our surgical team and the patient's gastroenterologist.

Recovery After Laparoscopic Cholecystectomy

Recovery from laparoscopic cholecystectomy is swift for the majority of patients.

Most patients go home on the day of surgery or the morning after. The small incisions cause minimal discomfort and heal quickly. Regular oral analgesia (paracetamol and anti-inflammatories) is usually sufficient for pain management. Nausea and bloating in the first day or two are common as the gas used during surgery disperses.

You can shower the day after surgery and resume light activities almost immediately. Driving should be avoided for at least 48 hours after general anaesthetic and while taking stronger pain medication. Most patients return to desk work within one to two weeks. Strenuous activity and heavy lifting should be avoided for two to four weeks.

Diet after cholecystectomy is an area of common concern. In the short term (the first one to two weeks), a low-fat diet helps minimise digestive symptoms while the body adjusts to bile flowing directly from the liver. In the longer term, the vast majority of patients are able to eat normally without dietary restriction. A small proportion of people experience ongoing loose stools or sensitivity to high-fat foods after gallbladder removal. This usually improves over time, and dietary adjustment and medication are available if symptoms persist.

Risks and Complications

Laparoscopic cholecystectomy is a very safe and commonly performed procedure. Complications are uncommon. Risks include infection at the wound or within the abdomen, bleeding, bile leak (from the cut surface of the liver or bile duct), injury to the bile duct or surrounding structures (rare but serious if it occurs, requiring specialist management), and a small chance of retained bile duct stones requiring subsequent ERCP.

All risks will be discussed in full at your pre-operative consultation.

Gallbladder Surgery at Breast & Surgical Oncology at The Poche Centre

Laparoscopic cholecystectomy is performed at The Mater Hospital and North Shore Private Hospital for private patients, and through public hospital pathways where appropriate. Our surgeons bring the same meticulous attention to preparation and technique to gallbladder surgery as to all procedures performed in our practice.

If you have been referred for gallbladder surgery, have symptomatic gallstones, or have questions about your options, we welcome a consultation.

This page is intended as a general guide only and does not replace personalised medical advice. Treatment decisions should always be made in consultation with your surgeon.