Dear Doc, 

I have a gallstone that is 2 cm which isn’t causing me any problems.

My family has a strong history of gallstone problems and my mother and younger sister have both had their gallbladder removed. 

Why is the gallbladder removed and not just the stone?

My sister’s gallbladder problems only began when she was pregnant, and my doctor has advised me to have my gallbladder removed before trying to conceive.

Is there any alternatives? What should I do? 

Confused

Dear Confused,

There’s two parts to this question.

First, when gall stones are causing problems why is the entire gallbladder removed rather than just the stone? This is because the gallbladder would almost always form more stones that would again cause more problems, since it has already done so once.

Given that the gallbladder has only a minor function anyway, and its absence is hardly of any significance, it makes sense that it be removed in order to reduce any future episodes.

Second, when is removal of the gallbladder indicated? Simply the presence of stones in the gallbladder is not an indication for its removal. This is because a significant proportion of the population have gallstones without ever causing any problems, so a lot of gallbladder surgery would end up taking place unnecessarily.

The only reason to have the gallbladder surgically removed (called a cholecystectomy) is if gallstones proven on ultrasound are causing symptoms.

Such symptoms include intermittent episodes of pain (biliary colic), acute inflammation/infection of the gallbladder (cholecystitis), or the even more serious possibility of stones blocking the pancreas resulting in pancreatitis.

So given that your gallstones aren’t causing you any problems (that is they are asymptomatic), it would be advisable for you to do nothing – especially not surgery – and you would have great difficulty in finding any good surgeon who would be prepared to remove it in your case anyway!

They could cause your problems one day, but then again statistics would say they will more likely not … so why go through surgery unless you actually need to?

Dr Ben