Gallstones are often discovered incidentally on an abdominal ultrasound, with no symptoms at all. The reasonable question is: “if they don't bother me, do I need surgery?”. The answer is individualised, but there are clear principles. See also the page on gallstones.

What “asymptomatic” gallstones means

Asymptomatic disease is gallstones that cause no pain or complications. Most people with gallstones remain asymptomatic for years. The typical “biliary colic” (intense pain in the right upper abdomen, often after a fatty meal) is the symptom that changes the picture.

The general principle: observation, not automatic surgery

In most patients with asymptomatic gallstones, prophylactic surgery is not recommended. The reasoning is that the yearly risk of developing symptoms is relatively low, and removal is mainly advised once symptoms appear.

When surgery is advised even without symptoms

There are, however, higher-risk situations where prophylactic laparoscopic cholecystectomy is discussed even without symptoms:

  • Very large stones (usually > 2–3 cm).
  • Multiple small stones (up to 6–7 mm), which may migrate and cause choledocholithiasis (stones in the bile duct) or pancreatitis.
  • Calcified / “porcelain” gallbladder (associated with increased cancer risk).
  • Gallbladder polyps > 1 cm or with high-risk features.
  • Diabetes mellitus or immunosuppression, where complications are more severe.
  • Haemolytic anaemia or a planned bariatric/other major operation.

The risks of waiting

Once symptoms appear, there is a risk of complications such as acute cholecystitis (inflammation), choledocholithiasis (a stone in the bile duct with jaundice) and pancreatitis. Planned surgery is generally safer than emergency surgery.

How the decision is made

The decision is individualised based on the size and number of stones, the ultrasound findings, coexisting conditions and the patient's wishes, after clear information about the benefits and risks.

If I have no symptoms, must I have surgery?

Not necessarily. In most asymptomatic cases observation is advised. Surgery is mainly discussed in higher-risk situations.

Which situations change the decision?

Very large stones, multiple small stones (up to 6–7 mm, which may migrate and cause choledocholithiasis or pancreatitis), a porcelain gallbladder, polyps >1 cm, diabetes and haemolytic anaemia are among the factors that may tip the balance toward surgery.

Is it dangerous to wait?

While you are asymptomatic, the risk is relatively low. Once symptoms or complications appear, treatment becomes more urgent — which is why follow-up matters.