I have gallstones and no symptoms, should I have surgery?

Asymptomatic gallstones generally do not need to be operated on. The indication for surgery depends on symptoms, examination findings, and individual characteristics that may increase the risk of complications.

Cholelithiasis (the presence of gallstones in the gallbladder) can remain asymptomatic for many years. Many people discover gallstones incidentally during an ultrasound or other imaging examination performed for a different reason.

Most people with asymptomatic gallstones remain symptom-free. Studies used in international guidelines estimate that about 10% to 20% of these patients develop symptoms over 10 years. The discovery of a gallstone does not automatically determine the need for surgery.

In asymptomatic patients, medical monitoring can be an option. Preventive surgery for gallbladder removal is not routinely indicated for all individuals with asymptomatic gallstones.

The indication for surgery may change when symptoms related to gallstones arise. Biliary colic (pain caused by temporary obstruction of the gallbladder outlet by a gallstone) typically causes pain in the upper right or central abdomen. The pain may appear after meals and last from a few minutes to several hours.

Gallstones can also cause complications. Cholecystitis (inflammation of the gallbladder) can occur when a gallstone blocks the gallbladder outlet. Persistent pain, fever, nausea, and vomiting may be present and require medical evaluation.

A gallstone can also exit the gallbladder and reach the bile ducts. The presence of gallstones in the bile ducts is called choledocholithiasis. Choledocholithiasis can cause obstruction of bile flow and promote complications such as jaundice, biliary tract infection, and pancreatitis.

Even in asymptomatic individuals, some findings may lead to consideration of surgical treatment. Gallstones larger than 3 cm and gallbladder polyps larger than 10 mm warrant specific evaluation. Porcelain gallbladder, wall thickening, and a gallbladder full of stones are also among the findings associated with an increased risk of gallbladder cancer.

The presence of risk factors such as large gallstones or polyps requires an individualized evaluation to determine the need for surgery. Individual risk, imaging examinations, and clinical conditions must be considered before recommending surgery.

When there is a surgical indication, the procedure performed is cholecystectomy (surgery for gallbladder removal). Laparoscopic cholecystectomy uses small incisions in the abdomen and a camera to allow the procedure to be performed.

The discovery of asymptomatic gallstones should be evaluated according to the characteristics of each patient. Monitoring may be sufficient for many people, while symptoms, complications, or certain examination findings may lead to the recommendation for gallbladder removal.

Severe or persistent abdominal pain, fever, vomiting, or jaundice (yellow skin and eyes) may be related to gallstone complications and require evaluation.