The three main treatments for gallstones are surgical removal of the gallbladder, oral dissolution therapy (a medication that slowly dissolves stones), and endoscopic removal of stones lodged in the bile duct. Which one applies to you depends on where your stones are, how large they are, and whether they’re causing symptoms. Many people with gallstones never need treatment at all.
Not All Gallstones Need Treatment
Most gallstones are “silent,” meaning they sit in your gallbladder without causing pain or complications. According to World Gastroenterology Organisation guidelines, removing the gallbladder provides no benefit for people with asymptomatic stones. Even after a single episode of uncomplicated gallstone pain, the risks of surgery can outweigh the risks of leaving the stones alone.
There are exceptions. Prophylactic surgery may make sense if you have a calcified “porcelain” gallbladder (which carries a higher cancer risk), if you’re immunosuppressed after an organ transplant, or if you live somewhere very remote from emergency medical care. People losing weight rapidly or cycling between weight loss and gain also face higher risk of complications and may benefit from earlier intervention.
Surgery: Gallbladder Removal
Surgical removal of the gallbladder, called cholecystectomy, is the most common and most definitive treatment. Because the gallbladder is where stones form, removing it eliminates the problem permanently. Your liver continues producing bile without it; the bile just flows directly into your small intestine instead of being stored first.
The vast majority of these surgeries are done laparoscopically, through a few small incisions in the abdomen. Recovery takes about two weeks, and most people return to work within one to two weeks. If you have a physically demanding job or exercise routine, you’ll likely need to scale back until you’re fully healed. In some cases, surgeons need to convert to an open procedure, which involves a larger incision. Recovery from open surgery is significantly longer: six to eight weeks.
After surgery, your body needs time to adjust to processing fat without a gallbladder. A common recommendation is to reintroduce fats gradually, spreading them throughout the day rather than eating large amounts in one sitting. Keeping fat below about 30 percent of your daily calories can help ease the transition. Increasing dietary fiber slowly over several weeks also helps normalize digestion.
Oral Dissolution Therapy
If surgery isn’t an option or your stones are small, a bile acid medication can dissolve cholesterol-based gallstones over time. This works by changing the chemical balance of your bile so it gradually breaks down the stones. It only works on cholesterol stones, not the pigment stones that make up a smaller share of cases, and it works best on stones smaller than 5 millimeters.
The results vary significantly by stone size. For small stones (5 mm or under), complete dissolution happens in about 81% of patients. Across all patients on high-dose therapy, the overall complete dissolution rate drops to around 37%. Treatment requires taking the medication daily for up to two years, so patience and consistency are essential.
The major drawback is recurrence. A long-term study published in Gastroenterology tracked patients for 12 years after successful dissolution and found that 12.5% had stones return within the first year. By the eleventh year, the cumulative recurrence rate reached 61%. This is why dissolution therapy is typically reserved for people who can’t safely undergo surgery rather than used as a first-line option.
Endoscopic Stone Removal (ERCP)
Sometimes gallstones slip out of the gallbladder and get stuck in the common bile duct, the tube that carries bile to your intestine. This can cause intense pain, jaundice, or dangerous infections. In these cases, the treatment is a procedure called ERCP, where a flexible tube with a camera is guided through your mouth, down through your stomach, and into the opening of the bile duct.
Once the scope reaches the blockage, the doctor can use tiny instruments threaded through the tube to break up and remove the stones directly. The whole procedure is done under sedation, so you’re not awake for it. ERCP is specifically designed for bile duct stones. It doesn’t treat stones still sitting in the gallbladder, so if you have stones in both locations, you may need ERCP for the duct stones followed by surgery to remove the gallbladder and prevent future episodes.
How the Three Treatments Compare
- Surgery is permanent and has the highest long-term success rate, but it removes an organ and requires one to two weeks of recovery (or six to eight weeks for open surgery).
- Oral dissolution avoids surgery entirely, but it only works on small cholesterol stones, takes up to two years, and stones come back in more than half of patients within a decade.
- ERCP is the go-to for stones trapped in the bile duct and can resolve an acute blockage without major surgery, but it doesn’t address stones remaining in the gallbladder.
For most people with symptomatic gallstones, laparoscopic surgery remains the standard recommendation because it solves the problem once. Dissolution therapy fills a niche for patients who aren’t surgical candidates, and ERCP handles the specific emergency of a blocked bile duct. In practice, many people end up with a combination: ERCP to clear a duct stone, followed by surgery to prevent it from happening again.