Most people have their gallbladder removed because of gallstones that are causing pain or complications. Gallstones are the overwhelming reason for the procedure, but a handful of other conditions can also make removal the best option. About 1.2 million cholecystectomies are performed in the United States each year, making it one of the most common surgeries.
Gallstones Are the Primary Reason
Your gallbladder is a small, pear-shaped organ that stores bile, a digestive fluid produced by the liver. Bile gets released into your small intestine after you eat to help break down fats. Gallstones form when substances in bile, usually cholesterol, harden into solid pieces. These stones can be as small as a grain of sand or as large as a golf ball, and many people have them without ever knowing.
In fact, most gallstones never cause problems. Only 10% to 20% of people with asymptomatic gallstones eventually develop symptoms within five to 20 years after diagnosis, at a rate of roughly 2% per year. If gallstones are discovered incidentally during imaging for something else and aren’t causing any trouble, the standard approach is to simply leave them alone.
The trouble starts when a gallstone blocks one of the ducts that carry bile. This produces what’s called a gallbladder attack: sudden, intense pain in the upper right abdomen that can radiate to the back or shoulder blade, often after a fatty meal. Nausea and vomiting are common. Once you’ve had one symptomatic episode, more are likely, and that’s when surgery enters the conversation.
Complications That Make Surgery Urgent
Sometimes gallstones don’t just cause pain. They cause dangerous complications that require prompt removal.
Cholecystitis, or inflammation of the gallbladder, happens when a stone gets lodged in the duct leading out of the gallbladder. The organ swells, and if left untreated, the tissue can become infected or even rupture. Fever, persistent pain lasting more than a few hours, and tenderness in the upper abdomen are classic signs. Acute cholecystitis is one of the most common reasons people end up in the emergency room needing gallbladder surgery.
Gallstone pancreatitis is another serious complication. The pancreatic duct and the common bile duct share an opening into the small intestine. When a gallstone blocks that shared opening, digestive enzymes produced by the pancreas can’t drain properly and begin damaging the pancreas itself. This causes severe abdominal pain, and complicated or severe pancreatitis can be life-threatening. After an episode of gallstone pancreatitis, removing the gallbladder prevents it from happening again.
A Sluggish Gallbladder Without Stones
Not everyone who needs their gallbladder removed has gallstones. Biliary dyskinesia is a condition where the gallbladder doesn’t empty properly, even though no stones are present. People with biliary dyskinesia experience the same kind of pain as gallstone patients, typically after eating.
To diagnose it, doctors use a specialized scan that measures how well the gallbladder contracts after being stimulated. A normal gallbladder empties at least 38% of its contents during the test. When the ejection fraction falls below that threshold and symptoms match, removal often provides relief.
Less Common Reasons for Removal
Gallbladder polyps, small growths on the inner wall, are usually harmless and found incidentally on ultrasound. Larger polyps carry a higher risk of being cancerous, so removal is typically recommended when a polyp reaches a certain size or shows signs of growth over time.
Porcelain gallbladder, a condition where calcium deposits stiffen the gallbladder wall, is quite rare. It was once thought to carry a high cancer risk, but current evidence suggests that risk is small overall. Cases where the calcium deposits are patchy rather than uniform may carry a somewhat higher risk of gallbladder cancer, and these are more likely to be treated with surgery.
What the Surgery Looks Like
The vast majority of gallbladder removals today are done laparoscopically, through a few small incisions in the abdomen using a camera and specialized instruments. Most people go home the same day or after one night in the hospital, and full recovery takes about one to two weeks.
Open surgery, which requires a larger incision, is less common and usually reserved for cases with significant inflammation, scarring, or complications that make the laparoscopic approach unsafe. Recovery from open surgery is considerably longer: two to three days in the hospital followed by four to eight weeks of healing at home.
Life Without a Gallbladder
You don’t need your gallbladder to digest food. After removal, bile flows directly from the liver into the small intestine in a continuous, low-level stream rather than being stored and released in concentrated bursts after meals. Your body adapts to this change, but the adjustment period can be noticeable.
In the first few weeks after surgery, fatty or greasy foods are the most likely to cause trouble. Keeping fat intake low (no more than 3 grams of fat per serving) for at least the first week helps ease the transition. Gradually increasing soluble fiber from sources like oats and barley can also help regulate bowel movements, though adding too much fiber too quickly tends to worsen gas and cramping.
Most people return to eating normally within a few weeks, but a subset of patients experience ongoing digestive issues. Estimates vary widely, with anywhere from 5% to 47% of people reporting some degree of persistent symptoms after surgery. The most common complaints are bloating, vague abdominal discomfort, and indigestion rather than the sharp, intense pain that gallstones cause. For most people in this group, the symptoms are mild and manageable, and they tend to improve over time as the body’s bile circulation adjusts to the absence of the gallbladder.