Gallstones are one of the most common reasons people in Chennai end up in a surgical outpatient department. For some, they cause years of discomfort that is mistaken for gastritis or “gas trouble”. For others, the first warning is a sudden, frightening attack of pain that lands them in an emergency room. Understanding what gallstones are, why they form, and when they actually need treatment can help you make a calm, informed decision rather than a panicked one.
What Exactly Are Gallstones?
The gallbladder is a small, pear-shaped pouch tucked under the right side of the liver. Its job is to store bile, a digestive fluid produced by the liver, and release it into the intestine when you eat a fatty meal. When the chemistry of bile becomes unbalanced — too much cholesterol, too little bile salts, or too much bilirubin — small crystals begin to form. Over months and years, these crystals grow into stones that can range from the size of a grain of sand to the size of a golf ball.
Most gallstones in India are cholesterol stones. A smaller number are pigment stones, which form in people with chronic blood disorders or repeated bile infections. Whatever the type, the problem begins only when a stone blocks the outlet of the gallbladder or slips into the bile duct.
Why Are Indians, Especially Women Over 40, at Higher Risk?
The classical teaching describes the typical patient as “fair, fat, female, fertile, and forty”. While the rhyme is dated, the underlying risk factors hold. Hormonal changes during pregnancy and menopause, rapid weight loss, diabetes, sedentary lifestyle, high-fat low-fibre diets, and a strong family history all push a person toward forming stones. North Indian women in particular have one of the highest reported rates of gallstones in the world, and southern states are catching up as urban lifestyles change. Obesity and insulin resistance — both increasingly common in Chennai’s working population — independently raise the risk.
Symptoms You Should Not Ignore
A surprising number of gallstones are silent. They are picked up incidentally on an ultrasound done for another reason and never cause trouble. The problem begins when a stone obstructs flow. The hallmark symptom is biliary colic — a steady, gripping pain in the upper right or middle of the abdomen, often after a heavy or oily meal, that may radiate to the right shoulder or back. Episodes typically last from thirty minutes to a few hours.
Watch for the following warning signs and seek medical attention if any develop:
- Sharp right upper abdominal pain, especially after fried or fatty food
- Nausea and vomiting that accompany the pain
- Bloating, belching, or persistent fatty food intolerance
- Yellow discolouration of the eyes or skin (jaundice)
- Dark, tea-coloured urine or pale, clay-coloured stools
- Fever with chills along with abdominal pain — a sign of infection
Jaundice, fever, or persistent pain suggests that a stone has moved into the bile duct or that the gallbladder itself is inflamed (cholecystitis). These situations need urgent evaluation, not home remedies.
Watchful Waiting Versus Surgery
Not every gallstone needs an operation. If a stone is discovered by chance and has never caused symptoms, in most adults it is reasonable to simply observe and review periodically. However, surgery is usually advised when stones have already caused even one true attack of pain, when the gallbladder wall is thickened, when there are multiple small stones (which can slip into the bile duct), when the patient has diabetes, or when there is a large stone over 2 cm. Patients with a porcelain (calcified) gallbladder or gallbladder polyps need surgery to reduce the risk of cancer.
There is no reliable medicine to dissolve gallstones in the way some advertisements claim. Ursodeoxycholic acid works only in a narrow set of patients with small, pure cholesterol stones and a functioning gallbladder, and stones often recur once the medication is stopped. Surgery remains the definitive treatment.
Laparoscopic Cholecystectomy: The Modern Standard
Laparoscopic cholecystectomy — keyhole removal of the gallbladder — is now the gold standard treatment for symptomatic gallstones. Four small cuts, each less than a centimetre, are made on the abdomen. A tiny camera and fine instruments are used to safely separate the gallbladder from the liver and bile duct, and the entire organ along with all its stones is removed through one of these small openings.
The advantages over the older open operation are substantial: minimal pain, no large scar, very low risk of wound infection, faster return to eating, and discharge usually within twenty-four hours. Most patients are back to office work in five to seven days. The liver continues to produce bile normally after surgery; bile simply drips directly into the intestine rather than being stored, and digestion adjusts quickly. A small number of patients notice loose motions after fatty meals for a few weeks, which usually settles on its own.
Life After Gallbladder Surgery
Almost everyone leads a completely normal life after gallbladder removal. There is no long-term special diet, no permanent medication, and no restriction on activity once the small wounds heal. A balanced Indian diet, regular meals, adequate water intake, and avoidance of binge eating are all that is usually advised.
The most important decision is choosing a surgeon and a centre that does laparoscopic gallbladder surgery routinely, with experience in handling difficult cases such as acute cholecystitis or unusual anatomy. Safe biliary surgery is, above all, about good judgment and meticulous technique.
Considering treatment for gallstones?
Dr. Gautham Krishnamurthy is a Consultant Surgical Gastroenterologist at P&G Hospital, Chennai, with specialised training in laparoscopic biliary surgery and the management of complex gallbladder and bile duct disease.
For appointments, please contact the P&G Hospital reception.