Tom Reeve Academic Surgical Clinic  ·  St Leonards

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Thomas J. HughSpecialist Hepato-Biliary & General Surgeon
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Patient resources · Gallstone treatment

Do gallstones always need surgery?

Gallstones found by chance commonly need no treatment when they have caused no symptoms. Surgery may be considered after typical recurring pain, gallbladder inflammation or another complication. The decision draws on symptoms, imaging, health, operative risk and personal preference.

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/ 01Overview

When can gallstones be observed?

Gallstones without symptoms are commonly observed because many remain quiet. A scan finding alone does not establish that surgery will help. Review becomes appropriate when new typical pain, fever, jaundice or another biliary problem develops.
/ 02Patient information

Which symptoms suggest gallstones are causing trouble?

Typical biliary pain is steady upper abdominal or right-sided pain that builds and lasts from about 30 minutes to several hours, sometimes with nausea or pain towards the back. Fever, persistent pain or jaundice can indicate a complication and require prompt assessment.
/ 03Patient information

When may surgery be considered?

Laparoscopic cholecystectomy may be considered for repeated typical biliary pain, acute cholecystitis, gallstone pancreatitis or bile-duct stones after the immediate problem has been assessed. Expected benefit is less certain when symptoms are vague or another diagnosis is more likely.
/ 04Patient information

Can gallstones be dissolved or removed without surgery?

Medicines have a limited role because they suit only selected cholesterol stones, act slowly and stones can return. Endoscopy can remove stones from the main bile duct but leaves the gallbladder in place. Observation remains a valid option for silent stones and selected patients.
/ 05Patient information

How is the treatment decision made?

Consultation checks whether the symptom pattern and imaging fit gallstone disease, then considers alternatives, material surgical risks, anaesthetic risk and your priorities. Public care or private care may be available, and you can take time to consider elective treatment.
/ 06Common questions

Many silent stones remain symptom-free. New typical pain, fever or jaundice should prompt reassessment.

One episode leads to assessment rather than an automatic operation. Symptom pattern, imaging, recurrence, complications and health all affect the recommendation.

Diet does not remove formed gallstones. Food choices may alter symptoms for some people while assessment and treatment decisions continue.

Antibiotics may form part of treatment for selected acute cholecystitis, alongside fluids, pain relief and a plan for drainage or surgery where appropriate.

Persistent severe pain, fever, jaundice, repeated vomiting, confusion or collapse require prompt medical assessment.

/ 07Evidence and review

What evidence supports this information?

Current independent guidelines provide the main basis for treatment information. Professor Hugh’s publications are listed separately as research and practice context, with the limits of each study stated.

Independent guidelines and reviews

  1. NICE guideline CG188: Gallstone disease, diagnosis and management. Evidence-based recommendations for assessment and management. Guidance applies to populations and requires individual clinical interpretation.
  2. 2020 World Society of Emergency Surgery guidelines for acute calculous cholecystitis. International guideline addressing diagnosis, operative timing and alternatives in acute cholecystitis.

Research involving Professor Hugh

These publications provide research and practice context. Their design, population and age limit how broadly each finding can be applied.

  1. Hugh. Gallstones: causes, diagnosis and treatment (2013). A clinical review written for its publication date. Current guideline recommendations take precedence where practice has changed.
  2. van Dijk et al. Systematic review of international guidelines (2017). A review that identified variation and limitations across available guidelines.
  3. van Dijk et al. Antibiotics for acute calculous cholecystitis (2016). A systematic review of limited evidence, supporting cautious interpretation of antibiotic treatment.
  4. Nguyen et al. Acute cholecystitis or biliary colic (2020). An observational cohort comparing emergency presentations; it cannot prescribe treatment for an individual.

Reviewed by Professor Thomas J. Hugh, MBBS, FRACS, MD

Published 25 August 2026. Last reviewed 25 August 2026.

/ 08Related reading

Last updated 25 August 2026