Gallstones
What Is A Gallstone?
Gallstones are solid deposits that form in the gallbladder, a small organ located beneath the liver that stores bile. This condition, known as gallstone disease or cholelithiasis, develops when there is an imbalance in the substances that make up bile, such as excess cholesterol or bilirubin, or when the gallbladder is not emptying fully, allowing bile to settle and form gristle and then stones.
The formation of gallstones can vary. Some people develop a single stone, while others may have multiple small stones. There are different types of gallstones, including cholesterol stones, pigment gallstones or stones that are a mix of both.
Several factors can increase risk, including diet, weight, age, and underlying health conditions. Understanding what causes gallstones can help explain why they develop, although in many cases, there is no single clear cause.
The pain is usually located in the upper abdomen and may occur after eating, particularly after fatty meals. The pain is typically on the right side but can be central, radiate around to the back or in rarer cases, present on the left.
One in six people in the UK have gallstones and the majority of them will never have symptoms from them. Once symptoms begin to recur, they will often persist until something is done to treat them.
Depending on their exact location, gallstones can cause a variety of issues. When located in the gallbladder, they can cause pain or infections. If they pass into the common bile duct, they can cause blockage of the liver and jaundice, or cause that duct to become infected - ascending choleangitis, which can make people very unwell.
If the stones get stuck further down that duct, they can obstruct the pancreatic duct, which causes pancreatitis. This condition is serious and almost always needs admission to hospital for support and monitoring.
There are rarer consequences of stones such as Mirezzi syndrome, where a large stone that is still in the gallbladder causes pressure and obstruction on the common bile ducts, or gallstones ileus, where a large stone erodes into the duodenum and gets itself stuck further down the small bowel, causing bowel obstruction.
What Are The Signs of Gallstones?
The signs and symptoms of gallstones often appear suddenly and can be painful. The most common symptom is gallstone pain, also known as biliary colic. This is typically felt as a sharp or cramping pain in the upper right abdomen, sometimes spreading to the back or shoulder.
Other signs and symptoms can include:
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Abdominal pain that comes and goes
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Nausea and vomiting
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A feeling of fullness or bloating
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Pain that lasts from a few minutes to several hours
In some cases, complications of gallstones can occur. These include cholecystitis, which is inflammation of the gallbladder, or blockage of the bile duct, which may lead to jaundice. In these circumstances the pain tends to be more constant and relatives may report that they can see a yellow tinge in the patient’s eyes. These situations often require prompt medical attention.
The diagnosis of gallstones usually begins with a clinical assessment of your symptoms and medical history. An ultrasound scan is the most widely used method to diagnose gallstones, as it provides a clear view of the gallbladder and can detect even small stones. In sicker patients a CT or MRI scan may be required to determine the exact anatomy or severity of the condition.
Treatments of Gallstones
Treatment options depend on the severity of symptoms and whether complications are present. Some people with gallstones do not require immediate treatment if they are not experiencing symptoms.
However, when symptoms are present or recurring, surgery is often recommended. The most effective treatment of gallstones is gallbladder removal, known as a cholecystectomy.
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Gallstones keyhole surgery: This minimally invasive approach uses small incisions to remove the gallbladder. It is the most common type of gallbladder surgery and typically allows for a faster recovery. In some circumstances some dye will be introduced into the biliary tree to check for escaped stones (an on table choleangiogram), and in some cases, these stones can be flushed through or retrieved during the operation (a common bile duct exploration)
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Open surgery: In some cases, a traditional surgical approach may be required, particularly if there are complications or previous procedures that make keyhole surgery unsuitable. The vast majority of cases can be dealt with laparoscopically in Mr Hornby’s practice.
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Endoscopic Treatments (ERCP): On some occasions it is necessary to clear the common bile duct of stones before proceeding to surgery to remove the gallbladder.
Your surgeon, Steve Hornby, will recommend the most appropriate treatment based on your symptoms, the type of gallstones, and your overall health.
Potential Complications
A laparoscopic cholecystectomy is a very safe procedure that is performed routinely. There are some recognised rare, but important risks, that are worthy of mention.
Bleeding - Most bleeding is seen and dealt with during the operation. On very rare occasions bleeding can require a return to the operating theatre to manage.
Infection - When seen, the commonest site for infection is the wound at the belly button. In rare cases infection can develop at the site the gallbladder is removed. It is normal for wounds to be a little red as they are healing but if there is excessive redness and discharge this can be a sign of infection and is treated with antibiotics.
Damage to liver or bowel - The liver occasionally sustains very minor damage as the gallbladder is removed but this rarely has any consequences for the patient and heals very quickly. Bowel injury is a more serious issue but is thankfully a very rare complication.
Damage to common bile duct - This is a potentially serious but very rare injury that may require further surgery to correct.
Bile leak - A bile leak is rare and usually presents several days following the procedure with the patient feeling unwell. It may require another laparoscopy to wash out any leaked bile and control the leak.
Retained Stone(s) - Stones can either be split from the gallbladder or travel down the bile pipes and cause a blockage. This is a rare complication that may require other procedures to manage.
DVT/PE - A clot in the legs (deep vein thrombosis) and lungs (pulmonary embolism) can occur following surgery but is rare following cholecystectomy. You will be asked to wear stockings on your lower legs whilst you are recovering and if you are at particular risk of developing a clot you may be given medication to thin your blood.
Risks of General Anaesthesia - General anaesthesia in the modern era is incredibly safe. You will be allocated an expert consultant anaesthetist. Anaesthetists are specially trained doctors and they will go through the small risks with you on the day of surgery.
Pain - It is normal to be sore following any surgery but that with regular simple painkillers this is very manageable. Patients occasionally have longer term pain that requires specialist management.
No resolution of symptoms - Unless Mr Hornby has a high degree of certainty that the patient’s symptoms are caused by their gallbladder he will not offer surgery. However on rare occasions the pain the patient is experiencing can continue.
Hernias - Hernias are a rare consequence of the small cuts made to do the operation. They are a gap in the muscle layer and sometimes need to be repaired at a further operation.
Diarrhoea - About 30% of people will experience a brief period of diarrhoea following removal of their gallbladder. This normally lasts a couple of weeks. About 1 in 200 people will have longer term diarrhoea that may need treatment with medication.
Other procedures - Occasionally, it is necessary to perform the operation through a larger incision, a so-called open procedure. This is exceedingly rare in Mr Hornby’s hands. The chances of this happening are less than 1 in 200. In very inflamed gallbladders, sometimes the safest thing to do is perform a sub-total procedure. This involves removing the vast majority of the gallbladder and all of the stone and leaving a tiny portion behind. This should have no long-term consequences for the patient but does necessitate an overnight stay with an abdominal drain for safety. In rare cases, the gallbladder is so scarred or inflamed that it is not safe to remove it and the case has to be abandoned. This decision is never taken lightly and always in the best interests of the patient.
What to Expect on the Day of Surgery
You will meet Mr Hornby and your anaesthetist on the day of the operation. Mr Hornby will get you to sign a consent form. All of the risks will have been discussed with you prior to this day.
You'll receive a general anaesthetic and will be asleep during the procedure. Mr Hornby will make one small incision in your belly button and insert a laparoscope, a thin tube with a camera, to guide the surgery. Instruments are then used to remove the gallbladder through 3-4 further small incisions.
What to Expect After the Surgery
Most patients go home the same day or the next morning. You may experience mild pain, shoulder discomfort, or bloating. You will be given regular medications that you should take without waiting for pain to start. You will wean off these over the next 14 days.
There are no specific dietary requirements following the procedure, in fact, you will likely be able to enjoy a much wider variety of foods again.
When Can I Get Back to Normal Activity?
You should be comfortable to mobilise around your home from the first day. Mr Hornby normally recommends two weeks off work. The hospital will provide you with a sick note for that period. He generally recommends you do not drive for 2 weeks and it is important that you avoid heavy lifting for 4-6 weeks.
When Should I Seek Medical Advice After the Procedure?
Contact Mr Hornby’s team or the private hospital if you experience persistent pain, fever, chills, nausea, vomiting, or signs of infection like redness, swelling, or drainage from the incisions.
Your Follow-Up Care and Recovery
The hospital will perform a wound check within the first couple of weeks of surgery and Mr Hornby will follow you up, either in person or via video consultation 4-6 weeks following surgery. These appointments will be arranged for you, and you will be contacted by email or letter.
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Initial consultation
Book an appointment with Steve Hornby, consultant general surgeon, to discuss your symptoms, concerns, and medical history. You will have time to ask questions and receive clear information about possible next steps.
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Personalised treatment plan
Care tailored to you. Following your consultation, a clear treatment plan is created based on your diagnosis, needs, and goals. This may include further investigations, treatment options, or preparation for surgery where appropriate.
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Treatment and recovery support
Care that continues beyond treatment. If surgery is required, it is delivered in modern clinical facilities, with recovery supported through onsite physiotherapy and follow-up care. Ongoing reviews ensure your recovery stays on track.
Ready to talk things through?
If you have questions or would like to discuss your symptoms, we’re here to help. You’re welcome to call 01242 386579, email admin@thehornbygroup.com, or use the contact form to get in touch.