Gallstones Explained: Biliary Colic, Cholecystitis, and When Surgery Is Necessary

More than 1 in 10 adults in Australia has gallstones. But here’s the thing-most of them never even know it. The pain doesn’t come from the stones themselves. It comes when one gets stuck. That’s when your body screams for help.

What Happens When a Gallstone Gets Stuck?

Imagine your gallbladder is a small storage tank for bile, the fluid your liver makes to digest fat. When you eat, it squeezes out bile through a narrow tube called the cystic duct. If a stone blocks that tube-even briefly-you get biliary colic.

This isn’t a dull ache. It’s a sharp, steady pain under your right ribs or in the middle of your belly. It hits fast, peaks within an hour, and lasts 1 to 5 hours. It doesn’t get better when you burp, pass gas, or throw up. You can’t just walk it off. And it doesn’t come with fever or jaundice-that’s the next step.

Up to 90% of people who have one episode of biliary colic will have another within 10 years. Two-thirds will be back in pain within just two years. That’s not luck. That’s the pattern. And each time it happens, the risk of something worse goes up.

When It Turns Serious: Cholecystitis

If the stone stays stuck for more than a few hours, your gallbladder starts to swell and inflame. That’s acute cholecystitis. Now you’re not just in pain-you’re sick.

You’ll likely have a fever, nausea, and your right upper belly will be tender to the touch. Your skin might turn yellow if the stone moves into the main bile duct. That’s called jaundice. You might even get pancreatitis if the stone blocks the pancreatic duct.

One in five people with biliary colic ends up here. And if you don’t get treated, your gallbladder can rupture. That’s life-threatening. The NHS says 20-30% of people with untreated symptomatic gallstones end up in emergency care within five years.

Doctors don’t wait. If you have cholecystitis, surgery should happen within 72 hours. Delaying increases the chance you’ll need open surgery instead of the minimally invasive kind. And open surgery means weeks of recovery-not days.

What Are Gallstones Made Of?

Not all stones are the same. In Western countries like Australia, about 80% are cholesterol stones. They form when your bile has too much cholesterol and not enough bile salts to keep it dissolved. The rest are pigment stones, made of bilirubin, a waste product from broken-down red blood cells.

Women are 2-3 times more likely to get them than men. Why? Estrogen increases cholesterol in bile and slows gallbladder emptying. Pregnancy, birth control pills, and hormone therapy all raise the risk. So do obesity, rapid weight loss, diabetes, and being over 40. Hispanic Australians have a 45% higher chance than non-Hispanic people.

And here’s the kicker: you can have dozens of stones the size of peas-or one big one like a golf ball. Size doesn’t predict symptoms. It’s all about location.

Can You Dissolve Gallstones Without Surgery?

You’ve probably heard about pills that dissolve stones. Ursodeoxycholic acid (UDCA) is real. It works-sometimes. But only for small, pure cholesterol stones. Success rates? 30-50% after 6 to 24 months of daily pills. And even if it works, half the people get stones back within five years.

Shockwave therapy (lithotripsy) used to be a popular option. It breaks stones into tiny pieces so they can pass. But it only works for single stones under 20mm. It’s messy, expensive, and rarely used anymore because recurrence is so high.

There’s also a new FDA-approved option for high-risk patients: endoscopic ultrasound-guided gallbladder drainage. It’s not a cure-it’s a bridge. It drains the gallbladder through a tiny tube, relieving pressure and infection without removing the organ. It’s for people too sick for surgery right now. But it’s not a long-term fix.

For most people, these aren’t real alternatives. They’re delays. And delays cost you time, comfort, and safety.

Why Laparoscopic Cholecystectomy Is the Gold Standard

Remove the gallbladder. That’s the cure. And the best way to do it? Laparoscopic cholecystectomy.

This isn’t a big cut. Surgeons make 3-4 tiny holes in your belly. They insert a camera and tools. They clip the ducts, cut the gallbladder loose, and pull it out. The whole thing takes 45 to 60 minutes. Most people go home the same day.

Compare that to open surgery: a 6-inch cut, 4-5 days in hospital, 30 days to recover. Laparoscopic surgery has a 95% patient satisfaction rate. Complication rates? Below 2% in experienced hands.

Recovery is fast. Walk within 4 hours. Drink liquids within 6. Eat light meals by dinner. Back to work in a week. No heavy lifting for 4-6 weeks. That’s the standard.

One woman in Cleveland Clinic’s 2023 patient story had 17 episodes of biliary colic over 18 months. After surgery, her pain vanished in 10 days. She was back to hiking in two weeks.

Who Shouldn’t Have Surgery?

Surgery isn’t risk-free. For healthy people under 75, the risk of dying within 30 days is about 0.1%. For someone over 75 with three or more chronic conditions-like heart disease, diabetes, or lung problems-that jumps to 2.8%.

That’s why doctors don’t rush. If you’re older and frail, they might try to manage symptoms with diet and pain control. But even then, the risk of complications like infection or bile duct injury stays high. Many end up in the hospital anyway.

There’s no magic age cutoff. It’s about your overall health, not your birthday. A 78-year-old who walks daily and manages their blood pressure might be a better candidate than a 65-year-old with uncontrolled diabetes.

What About Side Effects After Surgery?

Most people feel better than they have in years. But not everyone.

About 12% have ongoing diarrhea after surgery. It’s called post-cholecystectomy syndrome. Your body suddenly has to handle bile differently-no gallbladder to store it. That can make digestion less efficient, especially after fatty meals.

Another 6% get persistent pain. That’s not normal. It could mean a leftover stone, a bile leak, or even something unrelated like IBS. You need imaging and tests to find out.

On Reddit, 82% of people who had the surgery said their quality of life improved. The rest? Mostly those who waited too long or had undiagnosed problems.

What’s Next for Gallstone Treatment?

Surgeons are now using single-incision laparoscopic surgery (SILS)-one small cut instead of three. It leaves less scarring. But it’s harder to do. Complication rates are 20% higher than standard laparoscopy. It’s not the new standard yet.

Enhanced Recovery After Surgery (ERAS) protocols are making recovery faster. Eat before surgery. Don’t fast for 12 hours. Start walking within hours. These simple changes cut hospital stays by 30% and readmissions by 25%.

And the market is growing. With obesity rates rising and populations aging, more people will need this surgery. In the U.S., 700,000 gallbladder removals are done every year. That’s a $6.2 billion industry.

But here’s the bottom line: despite new tech, cholecystectomy remains the only reliable cure. Dissolving stones? Temporary. Draining the gallbladder? A stopgap. Surgery? Permanent.

What Should You Do If You Have Gallstones?

If you’ve been diagnosed with gallstones but never had symptoms-do nothing. Monitor. Eat healthy. Don’t lose weight too fast.

If you’ve had one episode of biliary colic? Talk to a surgeon. Don’t wait for the next one. The odds of recurrence are high. And each episode raises your risk of emergency surgery.

If you’re in pain right now-with fever, nausea, or jaundice? Go to the ER. Don’t wait. Don’t try to tough it out. This isn’t a stomach bug. It’s a medical emergency.

And if your doctor says, ‘Let’s wait and see’-ask why. If they’re not offering surgery as the main option, they’re not following current guidelines. The AAFP, SAGES, and Merck Manual all agree: for symptomatic gallstones, cholecystectomy is the standard.

You don’t need to suffer through 17 episodes like that woman in Cleveland. You don’t need to risk a ruptured gallbladder. You don’t need to be stuck in the hospital for weeks.

Surgery isn’t scary when you understand it. And it’s the only thing that gives you back your life.