Professor Thomas J. Hugh
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Research · Gallstones

Gallstones research and surgical evidence

Gallstones are solid deposits in the gallbladder, usually cholesterol or pigment. Most cause no symptoms until a stone blocks the cystic duct and triggers biliary colic or acute cholecystitis. Diagnosis relies on history and ultrasound. Definitive treatment for recurrent or complicated disease is usually laparoscopic cholecystectomy; asymptomatic stones are often observed after specialist assessment.

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This page explains gallstones in plain language, alongside peer-reviewed work by Thomas J. Hugh and colleagues.

Plain-language patient guide→
/ 01Key papers

Which of Professor Hugh’s papers should you read first?

These are the recent studies Professor Hugh recommends for anyone reading about gallstones, each with a plain-language summary of the findings and a link to the full paper.
/ 02Overview

What are gallstones and what causes them?

Gallstones are solid deposits that form in the gallbladder, usually from cholesterol or pigment. Common causes of gallstones include rapid weight loss, pregnancy, certain medicines, and a family history. Most stones stay silent; problems begin when a stone blocks the cystic duct and triggers biliary colic or inflammation.

Many Australians live with gallstones without knowing it. When symptoms appear, they often follow fatty meals and may feel like upper abdominal or right-sided pain that comes in waves.

In Hugh's 2013 Medicine Today review on gallstones, Tom Hugh emphasised that diagnosis rests on a clear history plus ultrasound, and that not every stone needs surgery.

/ 03Evidence

What gallstones symptoms should women watch for?

Gallstones symptoms in women mirror those in men: biliary colic (cramping upper abdominal pain), nausea, bloating, and pain after rich food. Pregnancy raises oestrogen and can promote stone formation. Fever, persistent pain, or jaundice suggest acute cholecystitis or a blocked bile duct and need urgent assessment.

Women often ask whether gallstones and pregnancy can overlap. Hormonal shifts can increase cholesterol saturation in bile, so symptoms may first appear during or after pregnancy.

Hugh and colleagues have published on emergency presentations, noting that telling simple biliary colic from acute cholecystitis changes timing of surgery and antibiotic use.

  • Typical biliary colic: 30 minutes to several hours, often after a fatty meal
  • Red flags: fever, yellow skin or eyes, pain that does not settle, vomiting
  • Pregnancy: discuss symptoms early with your GP or obstetric team
/ 04Evidence

Are gallstones dangerous if they are left alone?

Gallstones without symptoms are commonly observed after clinical assessment. Repeated typical pain, acute cholecystitis, pancreatitis or bile-duct stones can lead to a discussion about treatment. The recommendation depends on the presentation, imaging, health, expected benefits and material risks.

Patients frequently ask, are gallstones dangerous? The honest answer depends on symptoms and imaging, not stone size alone.

International guideline work co-authored by Hugh TJ (2017) compared how different countries manage gallbladder and bile duct stones, reinforcing early cholecystectomy for symptomatic disease.

/ 05Evidence

What does gallstones treatment in Australia involve?

Definitive gallstones treatment is usually laparoscopic cholecystectomy (keyhole gallbladder removal). Diet changes may ease attacks but do not dissolve most stones. Acute cholecystitis is often treated with antibiotics and early surgery when safe. ERCP may be needed if a stone is stuck in the bile duct.

Tom Hugh's 1992 prospective series of 100 laparoscopic cholecystectomy patients helped establish minimally invasive gallbladder surgery in Australian practice.

Later work from Hugh's group on total 5 mm port cholecystectomy and operative checklists reflects ongoing refinement of gallstones treatment Australia patients can expect in major centres.

SituationUsual approach
First episode biliary colicGP review, ultrasound, diet advice, plan follow-up
Recurrent biliary colicReferral for laparoscopic cholecystectomy
Acute cholecystitisHospital care, antibiotics, early surgery when feasible
Suspected bile duct stoneBlood tests, imaging, often ERCP before or during surgery
/ 06Evidence

How does laparoscopic cholecystectomy recovery usually go?

Many people go home on the day of keyhole gallbladder removal or after one night and return to desk work within one to two weeks. Activity increases according to the operation and individual recovery. Persistent fever or worsening abdominal pain should be reported promptly.

Hugh's team has studied difficulty scores for cholecystectomy after emergency admission, helping set realistic expectations when inflammation makes surgery harder.

From St Leonards and North Shore practice, Tom Hugh aligns operative planning with the same evidence he publishes, so patients and GPs share one consistent message.

/ 07Publications

Peer-reviewed publications by Thomas J. Hugh

The papers below are a selection of 72 papers from over 300 publications by Tom Hugh and collaborators, focused here on gallstones. Where a DOI or publisher link is available, it opens in a new tab so you can read the original research.
/ 08About the author

Who writes and operates from this evidence base?

Thomas J. Hugh is a specialist Upper GI and hepato-biliary surgeon and Chair of Surgery at the University of Sydney Northern Clinical School. He operates at Royal North Shore Hospital and North Shore Private, with consultations at the Tom Reeve Academic Surgical Clinic in St Leonards.

Outcomes across his practice are tracked through the DASO audit unit. That combination of published research and prospective audit is intended to keep advice grounded in measured results, not marketing claims.

Read more about Tom Hugh→
/ 09Common questions

Diet changes may reduce attacks, but stones rarely disappear without intervention. Once symptoms recur, surgeons usually recommend laparoscopic cholecystectomy because complications become more likely over time. Read about alternatives to surgery.

If you have severe or repeated attacks, surgery in the second trimester can be considered after specialist review. Mild symptoms are often managed conservatively until after delivery.

For uncomplicated biliary colic, antibiotics are not routine. Acute cholecystitis usually requires antibiotics; Hugh co-authored a 2016 systematic review on antibiotic treatment for acute calculous cholecystitis that informs current practice.

Most people tolerate a normal diet. The liver still makes bile; it flows continuously rather than being stored. A small number notice loose stools with very fatty meals early on.

/ 10Related reading

Other research topics

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

Last reviewed 25 August 2026.

Last updated 25 August 2026