By Dr Thomas Hanna MBChB, FRCS, MSc, PGCE, PhD and Dr Peter Swan MBChB, FRACS
Compass Surgical | MacMurray Centre, Auckland
This is the first article in our 8-part guide to gallstones and gallbladder surgery.
Gallstones are one of the most common digestive conditions affecting adults, yet many people know very little about them until they are diagnosed on an ultrasound scan.
Some people never develop symptoms. Others experience recurrent attacks of pain that can significantly affect their quality of life.
The most important thing to understand is that having gallstones does not automatically mean you need surgery.
The key question is not simply whether gallstones are present, but whether they are responsible for your symptoms.
In Article 2 of this series, Do Gallstones Go Away Without Surgery?, we discuss when observation may be appropriate and when surgery is more likely to help.
Gallstones are solid deposits that form inside the gallbladder.
The gallbladder is a small pouch beneath the liver that stores bile, a digestive fluid that helps break down fats. When you eat, particularly fatty foods, the gallbladder squeezes bile into the intestine to aid digestion.
Gallstones develop when substances within bile crystallise and gradually form stones. They may be as small as grains of sand or as large as several centimetres.
Most gallstones are made primarily of cholesterol, although some form from bile pigments produced during the normal breakdown of red blood cells.
Gallstones are extremely common, particularly as people get older, and many are discovered incidentally during scans performed for unrelated reasons.
Gallstones usually develop gradually over many years.
Factors associated with gallstone formation include:
Many patients assume they have caused the problem themselves.
In reality, gallstones often develop despite an otherwise healthy lifestyle and are usually the result of a combination of genetics, hormones and body chemistry.
Many gallstones cause no symptoms at all.
When symptoms occur, the most common pattern is known as biliary colic, which develops when a gallstone temporarily blocks the outlet of the gallbladder.
Typical symptoms include:
Many patients feel completely normal between attacks.
Patients commonly describe:
Many patients describe it as a pain that is impossible to ignore once it begins.
While attacks often occur after rich or fatty meals, they can also occur without an obvious trigger and may even wake patients from sleep.
Absolutely.
One of the most important principles in gallbladder surgery is recognising that not all upper abdominal pain is caused by gallstones.
Other conditions that can produce similar symptoms include:
Finding gallstones on an ultrasound does not automatically prove they are responsible for your symptoms.
This is why treatment decisions should never be based on scan results alone.
At Compass Surgical, we take time to understand the pattern of symptoms, review investigations carefully, and consider whether alternative explanations should be explored before recommending treatment.
Most gallstone attacks settle without causing lasting harm.
However, you should seek urgent medical assessment if you develop:
Additional patient information about gallstones and gallbladder disease is available through the Royal Australasian College of Surgeons (RACS) patient information resources and Healthify NZ.
These symptoms may indicate infection, inflammation of the gallbladder, bile duct blockage or pancreatitis and require prompt assessment.
No.
Many people live their entire lives with gallstones and never require treatment.
For patients with typical symptoms, surgery is often the most effective long-term treatment. If surgery is being considered, Article 5 of this series explains what happens during laparoscopic gallbladder surgery and what patients can expect before, during and after the procedure.
For others, observation may be entirely reasonable.
The decision depends on the pattern of symptoms, the impact on quality of life, overall health, and individual preferences.
At Compass Surgical, we focus on treating patients rather than treating scan results.
Compass Surgical was founded on a simple principle:
Recommend surgery when it is likely to help. Avoid surgery when it is unlikely to help.
Our approach combines:
Working within the multidisciplinary environment of the MacMurray Centre allows us to collaborate closely with gastroenterologists, dietitians and other specialists when additional assessment is needed.
The goal is not simply to identify gallstones.
The goal is to determine whether they are genuinely responsible for your symptoms and whether treatment is likely to improve your quality of life.
Now that we’ve covered what gallstones are and the symptoms they can cause, the next question is often the most important:
“Do gallstones always need surgery?”
The answer is no.
Many people live with gallstones for years without requiring an operation, while others benefit significantly from gallbladder removal.
Understanding when surgery is appropriate, and when observation may be reasonable, is one of the most important parts of managing gallstone disease.
In the next article, “Do Gallstones Go Away Without Surgery?”, we’ll explore conservative management, what the latest evidence tells us, and how surgeons help patients decide between observation and surgery.
We’ll then move on to another important topic: biliary dyskinesia, a condition in which patients may experience gallbladder-type symptoms despite having no gallstones visible on ultrasound.
If you have been diagnosed with gallstones or are experiencing symptoms that may be related to gallbladder disease, 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 individual circumstances.
Whether the right answer is reassurance, observation or surgery, our goal is to help you 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 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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