Gallstones (Cholelithiasis)

Gallstones (cholelithiasis) are hardened deposits that form within the gallbladder, composed primarily of cholesterol, bilirubin pigment, or a mixture of both. India has a particularly high prevalence of pigment stones — especially black pigment stones associated with haemolytic anaemias and brown pigment stones linked to biliary infections — alongside cholesterol stones. Risk factors for cholesterol gallstones include the "5 Fs": Female, Fat, Forty, Fertile, and Family history, as well as rapid weight loss, prolonged fasting, and certain medications. Gallstones are present in an estimated 5–10% of the Indian adult population, with a substantial proportion becoming symptomatic over a lifetime.

Most gallstones (approximately 80%) are asymptomatic (silent stones) and discovered incidentally on ultrasound. When gallstones cause symptoms, the classic presentation is biliary colic — episodic, intense right upper quadrant or epigastric pain that begins 30–60 minutes after a fatty meal, lasts 1–5 hours, and radiates to the right shoulder or back. Complications include acute cholecystitis (infection and inflammation of the gallbladder), choledocholithiasis (stones migrating into the common bile duct causing obstructive jaundice and cholangitis), gallstone pancreatitis, and — rarely — gallbladder perforation or gallstone ileus. Abdominal ultrasound is the first-line investigation; MRCP or ERCP is used when common bile duct stones are suspected.

Laparoscopic cholecystectomy (keyhole surgery) is the gold-standard treatment for symptomatic gallstones and is one of the most commonly performed operations worldwide. It is performed through three or four small incisions using a camera and instruments, resulting in less pain, shorter hospital stay (often same-day or overnight), and rapid return to normal activity compared to open surgery. For common bile duct stones detected preoperatively, ERCP with sphincterotomy and stone extraction is performed, usually before or during the same admission as cholecystectomy. Our HPB surgeons manage all complexities of gallstone disease including Mirizzi syndrome, porcelain gallbladder, and previous complex cholecystitis requiring careful open conversion.