The most common reason people have their gallbladder removed is gallstones that are causing pain or complications. Around 700,000 gallbladder removals are performed each year in the United States, making it one of the most frequently performed surgeries. An estimated 20 million Americans have gallstones, though most will never need surgery because their stones never cause problems.
Gallstones Are the Primary Reason
Gallstones form when substances in bile, the digestive fluid your gallbladder stores, harden into pebble-like deposits. They can be as small as a grain of sand or as large as a golf ball. Many people carry gallstones for years without knowing it. These “silent” gallstones are typically discovered by accident during imaging for something else, and they don’t require treatment. Only about 2% of people with asymptomatic gallstones develop symptoms in any given year.
The trouble starts when a stone shifts and blocks one of the ducts that carry bile from the gallbladder to the small intestine. This causes what’s known as a biliary attack: sudden, intense pain in the upper right side of the abdomen that can radiate to the right shoulder or back. The pain often hits after a fatty meal and can last anywhere from 30 minutes to several hours. Once you’ve had one attack, more are likely, and surgery becomes the standard recommendation.
Stones can also migrate into the common bile duct, the larger channel that connects the liver and gallbladder to the intestine. A stone lodged there can cause jaundice (yellowing of the skin and eyes), infection, and a backup of bile that affects the liver. This is a more urgent situation than stones sitting quietly inside the gallbladder itself.
Gallbladder Inflammation
When a gallstone gets wedged in the neck of the gallbladder and stays there, the gallbladder becomes inflamed. This condition, called cholecystitis, goes beyond the cramping pain of a simple gallstone attack. The pain in the upper right abdomen persists for more than three to six hours, often accompanied by fever, nausea, vomiting, and loss of appetite. Some people also develop an abdominal mass that a doctor can feel during an exam.
Cholecystitis is considered a major complication of gallstones, and it typically requires prompt surgical removal. Left untreated, the inflamed gallbladder can develop gangrene, rupture, or cause a serious abdominal infection. Most people who develop cholecystitis have experienced at least one prior episode of biliary pain, which is why doctors often recommend removal after a first symptomatic gallstone episode rather than waiting for things to escalate.
Gallstone-Triggered Pancreatitis
One of the more dangerous reasons for gallbladder removal is pancreatitis caused by a gallstone blocking the pancreatic duct. The gallbladder, liver, and pancreas share a common drainage pathway into the small intestine. When a stone blocks that shared channel, digestive enzymes produced by the pancreas can’t flow out normally. Pressure builds in the pancreatic duct until those enzymes activate prematurely, essentially digesting the pancreas itself from the inside.
This causes severe abdominal pain, often radiating to the back, along with nausea, vomiting, and in serious cases, organ failure. The stone has to pass on its own or be removed to resolve the episode. After recovery, the gallbladder is removed to prevent it from happening again, since a second episode of gallstone pancreatitis carries the same risks as the first.
Gallbladder Polyps and Cancer Concerns
Not every gallbladder removal involves stones. Polyps, which are small growths on the inner wall of the gallbladder, are another reason for surgery. Most gallbladder polyps are harmless and small, but larger ones carry a risk of becoming cancerous. European guidelines recommend surgical evaluation for any polyp larger than 1 centimeter. Polyps between 6 and 9 millimeters may also warrant removal if a person has certain risk factors, including age over 60.
Gallbladder cancer itself is rare, but when there’s suspicion based on imaging or other findings, removal is the primary treatment. Because gallbladder cancer is difficult to detect early and aggressive when advanced, doctors tend to err on the side of removal when imaging raises concern.
Poor Gallbladder Function Without Stones
Some people experience classic gallbladder symptoms, including pain after fatty meals, nausea, and bloating, but no gallstones show up on imaging. This is called biliary dyskinesia, a condition where the gallbladder doesn’t contract and empty properly. To diagnose it, doctors use a specialized scan that measures how well the gallbladder empties after being stimulated. A gallbladder that empties less than 38% of its contents is considered abnormally sluggish. For people with both symptoms and a low ejection fraction, gallbladder removal often provides relief.
When Surgery Isn’t Necessary
Having gallstones doesn’t automatically mean you need surgery. If stones are found incidentally and you’ve never had symptoms, the best approach is typically to leave them alone. In one study that followed adults with symptomatic gallstones who chose not to have surgery, only about half eventually needed the operation over a median follow-up of nearly six years. Watchful waiting is a reasonable option for people whose symptoms are mild or infrequent, though the risk of complications like cholecystitis or pancreatitis remains as long as the gallbladder is in place.
What Happens to Digestion Afterward
Your gallbladder’s job is to store bile produced by the liver and release a concentrated burst of it when you eat fatty foods. Without a gallbladder, your liver still produces bile, but instead of being stored and released on demand, it drips continuously into the small intestine. This means your body can still digest fats, just less efficiently at first.
Most people adjust within a few weeks to a few months. During that transition period, you may notice more frequent bowel movements or looser stools, particularly after high-fat meals. Some people find that eating smaller, more frequent meals with moderate fat content helps ease the adjustment. Over time, the digestive system adapts, and the majority of people return to eating normally without lasting restrictions.