What are gallstones?
Cholelithiasis is the presence of stones inside the gallbladder — a small pear-shaped organ beneath the liver that stores bile. Stones may be single or multiple, ranging from a few millimetres to several centimetres, and form when the balance of bile components (cholesterol, bile acids, bilirubin) is disturbed.
The majority of stones are asymptomatic and are discovered incidentally on ultrasound. When they cause symptoms or complications, removal of the gallbladder (cholecystectomy) is indicated.
How common is it?
Cholelithiasis is one of the most common digestive conditions in the Western world. In Greece and Europe it is estimated to affect approximately 10–15% of the adult population. Prevalence increases with age (up to 25–30% in people over 60) and is roughly twice as common in women as in men, particularly during reproductive years.
Of patients with gallstones, about 20–30% will develop symptoms within the next 20 years. The most common complication is biliary colic, while acute cholecystitis, pancreatitis or common bile duct obstruction are less frequent.
How does it present?
The main symptoms of gallstones include:
- Biliary colic: intense pain in the right upper quadrant or epigastrium, typically appearing 30–90 minutes after a fatty meal.
- Radiation of pain to the right scapula or back.
- Nausea and vomiting.
- Bloating and a feeling of abdominal heaviness.
- Fever, chills and jaundice in complicated disease (acute cholecystitis, cholangitis, choledocholithiasis).
How is it diagnosed?
Diagnosis is usually straightforward and based on history, clinical examination and simple imaging:
- Upper abdominal ultrasound — the investigation of choice, with sensitivity >95% for gallstones.
- Laboratory tests (CBC, biochemistry, liver enzymes, amylase/lipase).
- Magnetic resonance cholangiopancreatography (MRCP) when a stone in the common bile duct is suspected.
- Abdominal CT or ERCP in complicated cases.
Which factors increase risk?
There is a clear genetic and familial predisposition to gallstones. First-degree relatives of patients with gallstones have a 2–5 fold higher risk. Polymorphisms have been identified in genes related to cholesterol metabolism (ABCG5/G8, ApoE, CYP7A1).
- Family history of gallstones in close relatives.
- Female sex, pregnancy, oral contraceptives or hormone therapy.
- Obesity, metabolic syndrome, diabetes mellitus, hypertriglyceridemia.
- Rapid weight loss, prolonged fasting or parenteral nutrition.
- Ethnic predisposition (increased in Pima and Mediterranean populations).
- Crohn's disease, cirrhosis, hemolytic anemias.
Modern therapeutic options
The choice of the appropriate technique is individualised for each patient, based on disease stage, anatomy, comorbidities and patient preference.
Laparoscopic Cholecystectomy
The international gold standard for symptomatic gallstones. Performed through 4 small incisions (5–12mm) using a camera and specialised instruments. Provides excellent visualisation of structures and safe removal of the gallbladder.
Robotic Cholecystectomy
For selected cases with difficult anatomy or suspected complications. The Da Vinci system offers three-dimensional visualisation and robotic instruments with 7 degrees of freedom, allowing more precise dissection of Calot's triangle.
Open Cholecystectomy
Rare today — reserved for patients with severe inflammatory adhesions, multiple prior operations, or when conversion from laparoscopy is required for patient safety.
Frequently asked questions
Will I be able to eat normally after cholecystectomy?
The vast majority of patients return to a fully normal diet within a few weeks. For the first 2–4 weeks, avoidance of fatty and fried foods is recommended. Bile continues to be produced by the liver and to reach the intestine — simply without the temporary storage station.
Can the stone be dissolved with medication or diet?
No. There is no proven medical or dietary treatment that effectively and permanently dissolves gallstones. Medications such as ursodeoxycholic acid may be tried in selected cases but with low success rates and high recurrence.
Should I have surgery if I have no symptoms?
In most patients with asymptomatic gallstones, prophylactic surgery is not recommended. There are exceptions however (very large stones, calcified gallbladder, polyps, diabetes mellitus) where prophylactic removal is discussed.
How quickly can I return to work?
With the laparoscopic technique, most patients return to office work within 5–7 days. For work requiring physical effort, the recommendation is 2–3 weeks.