By Dr Thomas Hanna MBChB, FRCS, MSc, PGCE, PhD and Dr Peter Swan MBChB, FRACS
Compass Surgical | MacMurray Centre, Auckland
This is the second article in our 8-part guide to gallstones and gallbladder surgery.
In our first article, What Are Gallstones and What Symptoms Do They Cause?, we discussed how gallstones form and the symptoms they may cause.
One of the next questions patients often ask is:
“Do I really need surgery, or can I leave them alone?”
It’s an understandable question. Most people would prefer to avoid an operation if possible, but they also want to avoid future pain, hospital admissions and complications.
The answer is that it depends.
Some people live with gallstones for years without further problems. Others develop recurrent attacks that eventually make surgery the most sensible option. The challenge is determining which approach is most likely to benefit you.
Usually not.
Gallstones are solid deposits that form within the gallbladder. Once they have formed, they generally remain there unless the gallbladder is removed.
Unlike kidney stones, gallstones rarely pass naturally.
This means that symptoms may settle, but the stones themselves usually remain present.
Sometimes, yes.
Depending on your symptoms and circumstances, management may include:
These approaches do not remove the gallstones, but they may allow some patients to avoid or defer surgery.
The important question is not whether gallstones are present. The important question is whether they are causing symptoms significant enough to justify an operation.
Many patients seek surgical advice after a single episode of biliary colic.
There is no single correct answer.
Some patients experience one attack and never have another. Others develop recurrent symptoms within weeks or months.
For patients who have had a severe attack, travel frequently, have demanding work commitments, or simply want a definitive solution, surgery after a single episode may be entirely reasonable.
Equally, some patients prefer to wait and see whether symptoms recur before making a decision.
Both approaches can be appropriate.
The best choice depends on symptom severity, quality of life, overall health and personal preference.
Recent studies suggest that not every patient with symptomatic gallstones requires immediate surgery.
Research has shown that while recurrent symptoms are common overall, some patients remain symptom-free for prolonged periods after an initial attack.
This does not mean surgery is unnecessary.
Rather, it reinforces the importance of individualised decision-making. Gallstone disease does not follow the same course in every patient.
Further patient information about gallstones and treatment options is available through Healthify NZ and the Royal Australasian College of Surgeons (RACS).
No.
Dietary changes may reduce symptoms for some patients, but they do not remove existing gallstones.
Many people notice attacks are triggered by:
Reducing these foods may decrease the frequency of attacks, but dietary modification should be viewed as symptom management rather than a cure.
Gallbladder removal remains the most effective long-term treatment for symptomatic gallstones.
Potential benefits include:
Many patients choose surgery because they are tired of wondering when the next attack might occur.
One of the biggest mistakes in gallstone management is assuming that all upper abdominal symptoms are caused by gallstones.
Finding gallstones on an ultrasound scan does not automatically mean they are responsible for the symptoms.
Other possible causes include:
Removing the gallbladder only helps if the gallbladder is genuinely responsible for the symptoms.
This is why we take time to carefully review symptoms, investigations and alternative explanations before recommending treatment.
At Compass Surgical, we do not believe every patient with gallstones should automatically have surgery.
Equally, we do not believe surgery should be delayed unnecessarily when it is likely to improve quality of life.
Our role is to help patients understand their options and make informed decisions that align with their goals, lifestyle and preferences.
Our approach is built around:
Gallstones are the most common cause of gallbladder-related symptoms, but they are not the only cause. Some patients experience symptoms that sound very similar to biliary colic despite having no gallstones visible on ultrasound.
This condition is known as biliary dyskinesia.
In Article 3 of 8, What Is Biliary Dyskinesia?, we’ll explore how this condition is diagnosed, why it can be difficult to identify, and when gallbladder surgery may still have a role even when no gallstones are present.
If you have been diagnosed with gallstones and are unsure whether surgery is necessary, Compass Surgical can help.
Working closely with your GP and the multidisciplinary team at the MacMurray Centre, we provide personalised, evidence-based advice tailored to your circumstances.
For some patients, observation is entirely appropriate. For others, surgery may offer the best long-term solution. Our role is to help you understand your options and make an informed decision with confidence.
Contact Compass Surgical to arrange a consultation.
Article 1 of 8 – What Are Gallstones and What Symptoms Do They Cause?
Article 2 of 8 – Do Gallstones Go Away Without Surgery?
Article 3 of 8 – What Is Biliary Dyskinesia?
Article 4 of 8 – What About Gallbladder Polyps?
Article 5 of 8 – What Is Laparoscopic Gallbladder Surgery?
Article 6 of 8 – What Are the Risks of Gallbladder Surgery?
Article 7 of 8 – Recovery After Gallbladder Surgery
Article 8 of 8 – Why Your Follow-Up Appointment Matters After Gallbladder Surgery?
Dr Thomas Hanna MBChB, FRCS, MSc, PGCE, PhD
Dr Thomas Hanna is a general and transplant surgeon practising in Auckland. He trained in the United Kingdom before moving to New Zealand in 2019. He has specialist interests in gallbladder surgery, hernia repair, minimally invasive surgery and complex abdominal surgery. Tom is a founding partner of Compass Surgical and is committed to patient-centred surgical care, clear communication and surgery performed with integrity.
Dr Peter Swan MBChB, FRACS
Dr Peter Swan is a general surgeon practising in Auckland with expertise in gallbladder surgery, hernia repair and general surgical conditions including lumps and bumps. He is a founding partner of Compass Surgical. Peter’s practice focuses on practical, evidence-based advice, careful patient selection and personalised treatment.
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