Gallstones are almost always removed by taking out the entire gallbladder, not by plucking individual stones from it. The standard procedure is laparoscopic cholecystectomy, a minimally invasive surgery that uses small incisions and a camera. When stones are stuck in the bile duct rather than the gallbladder itself, doctors use a separate, non-surgical technique to retrieve them. There are also medication-based options, though they work slowly and only for certain types of stones.
Laparoscopic Surgery: The Standard Approach
About 90% of gallbladder removals today are done laparoscopically. The surgeon makes four small incisions in your abdomen, each roughly 5 to 12 millimeters wide. One goes near the belly button for a tiny camera, one below the breastbone for dissecting tools, and two on the right side of your abdomen for grasping and cutting instruments. Carbon dioxide gas inflates your abdomen to give the surgeon room to work and see clearly on a video monitor.
The surgeon carefully clears tissue away from the area where the gallbladder connects to the bile duct and its blood supply. This step is critical: the surgical team needs to confirm they can see exactly two structures entering the gallbladder (the cystic duct and cystic artery) before cutting anything. Once confirmed, both are sealed with small metal clips and divided. The gallbladder is then separated from the underside of the liver using an electrified cutting tool, placed in a small retrieval bag, and pulled out through the belly button incision.
The whole operation typically takes 30 to 60 minutes. Most people go home the same day.
When Open Surgery Is Needed
Sometimes the laparoscopic approach isn’t possible, and the surgeon needs to switch to an open operation through a larger incision under the right ribcage. This happens when severe inflammation, scar tissue from previous surgeries, or unusual anatomy makes it unsafe to identify structures through the camera. Uncontrolled bleeding during the procedure is another reason to convert.
Two gallbladder conditions almost always require a planned open surgery from the start. Suspected gallbladder cancer calls for a wider operation to ensure complete removal. Mirizzi syndrome, where a stone compresses or erodes into the main bile duct, also typically needs open access because the anatomy is too distorted for a laparoscopic approach. Patients with severe liver cirrhosis may also be scheduled for open surgery due to the complexity of operating on a scarred liver.
Removing Stones From the Bile Duct
Stones don’t always stay in the gallbladder. They can slip into the common bile duct, the tube that carries bile from the liver to the small intestine. When that happens, doctors use a procedure called ERCP (endoscopic retrograde cholangiopancreatography) to retrieve them without any external incisions.
During ERCP, a flexible scope is passed through your mouth, down through the stomach, and into the upper part of the small intestine where the bile duct empties. The doctor threads a thin catheter into the duct opening and injects dye so the duct shows up clearly on X-ray. Using real-time imaging, the doctor can see exactly where stones are lodged, then pass tiny tools through the scope to widen the duct opening and pull the stones out or push them into the intestine. This is often done before or after gallbladder surgery, depending on when the duct stones are discovered.
Dissolving Stones Without Surgery
Oral bile acid therapy can dissolve certain gallstones, but it works only under specific conditions. The stones must be cholesterol-based (called “radiolucent” because they don’t show up well on X-rays), smaller than 10 millimeters, and sitting in a gallbladder that still contracts normally. Larger cholesterol stones can also be treated, though success rates drop.
Treatment with ursodeoxycholic acid, a medication that gradually dissolves cholesterol in bile, typically takes over six months and often a year or longer. Dissolution rates improve with higher doses and longer treatment. The major downside is that stones frequently come back after you stop taking the medication, since the gallbladder that formed them in the first place is still there. For this reason, medication is generally reserved for people who can’t safely undergo surgery.
Options for Patients Too Sick for Surgery
For people with severe gallbladder infection who are too ill or frail to tolerate an operation, doctors can place a drainage tube directly through the skin and into the gallbladder. This percutaneous cholecystostomy relieves pressure and infection within 24 to 48 hours. Once the infection clears and the patient stabilizes, surgeons reassess whether gallbladder removal is feasible, typically waiting at least six weeks before operating.
For patients who will never be healthy enough for surgery, the drainage tube stays in place for a minimum of three weeks. After imaging confirms that bile is flowing freely through the duct system, the tube can be removed. This approach manages the acute crisis without removing the gallbladder itself.
Recovery After Gallbladder Removal
Recovery from laparoscopic surgery takes about two weeks. Most people return to work within one to two weeks, though jobs involving heavy lifting or physical labor may require a modified schedule until you’re fully healed. Open surgery recovery is significantly longer, around six to eight weeks.
Your diet will need a temporary adjustment. Starting with bland, simple foods works best in the first days after surgery. High-fat and high-fiber meals are often harder to digest initially because bile now drips continuously into your intestine rather than being stored and released in concentrated bursts. Most people return to a normal eating pattern within a few weeks, though the timeline varies.
Digestive Changes After Surgery
Removing the gallbladder solves the stone problem, but somewhere between 5% and 47% of patients experience ongoing or new digestive symptoms afterward, a range known as post-cholecystectomy syndrome. The wide range reflects how differently researchers define the condition: some count lingering pre-surgery symptoms, while others only count symptoms that are new or worse after the operation.
These symptoms can include abdominal pain, bloating, diarrhea (especially after fatty meals), and nausea. The causes are varied. Changes in how bile flows, shifts in gut bacteria, and occasionally a missed stone in the bile duct can all play a role. For most people, symptoms are mild and improve over time. Persistent or worsening symptoms warrant follow-up to rule out a structural problem like a retained stone or bile duct narrowing.
Do Painless Gallstones Need Removal?
If gallstones were found incidentally on an imaging scan and have never caused symptoms, surgery is generally not recommended. Guidelines from both the National Institutes of Health and the Society of American Gastrointestinal and Endoscopic Surgeons advise against removing an asymptomatic gallbladder in most people, since the risks of surgery outweigh the small chance the stones will ever cause trouble.
There are exceptions. Prophylactic removal may be considered if you have gallstones larger than 3 centimeters, stones in the bile duct (even without symptoms, up to 50% of these patients develop serious complications), sickle cell disease or hereditary spherocytosis, significant immunosuppression from transplant medications, gallbladder polyps over 1 centimeter, or certain risk factors for gallbladder cancer such as a porcelain gallbladder or anomalous duct anatomy. Younger patients and those living far from medical facilities are also sometimes offered surgery, since the cumulative lifetime risk of a stone-related emergency is higher.
Complication Rates
The most serious risk of gallbladder surgery is injury to the bile duct. During open surgery, clinically significant bile leaks occur in 0.1% to 0.5% of cases. With laparoscopic surgery, that rate is slightly higher, up to 3%, largely because the indirect camera view can make it harder to distinguish the bile duct from the cystic duct. This is why surgeons follow a strict identification protocol before cutting any structures. If a bile duct injury does occur, it can usually be repaired, though it sometimes requires additional procedures.