How Gallbladder Disease Is Treated

The treatment of gallbladder disease depends on the type of disease. The most common manifestation of gallbladder disease is gallstones, which are hardened pieces of digestive fluid or bile in your gallbladder.

When it comes to treating gallstones, there are generally three options—a "watch and wait" approach if there are no symptoms, procedures to remove the gallbladder and/or destroy the stones, or medication to break up the gallstones.

Treating other gallbladder or bile duct problems, such as a stone that is lodged in the common bile duct, may require a more specialized procedure called an ERCP.

This article discusses the types of treatment available for gallbladder disease, including surgeries, procedures, and medication. It also discusses lifestyle changes that may help prevent it.

Surgeries and Specialist-Driven Procedures

The primary treatment for the vast majority of gallbladder diseases is the surgical removal of the gallbladder, called a cholecystectomy.

Most gallstones cause no symptoms and therefore do not warrant treatment. When they do cause pain, though, surgery is generally needed.

However, there are non-surgical procedures, mostly for people who are too high-risk to undergo surgery. The downside of non-surgical options is that the gallbladder is still present, so gallbladder disease (mainly gallstones) may recur.

Cholecystectomy

A cholecystectomy is the most effective treatment for gallbladder disease. It's performed under general anesthesia in an operating room.

Laparoscopic Cholecystectomy

In the vast majority of people, this surgery is done laparoscopically. This involves the surgeon inserting a thin, flexible instrument (with a video camera at the end) through a small cut in the abdomen. Using long instruments, the surgeon will make multiple small puncture holes in the abdomen, and remove the gallbladder.

A laparoscopic cholecystectomy is done on an outpatient basis. You'll likely be able to return to normal activity levels after a week.

Open Cholecystectomy

In an open cholecystectomy, a large abdominal cut is made to remove the gallbladder. It's usually performed when your gallbladder is severely inflamed, infected, or scarred.

This surgery is more invasive and takes longer to recover from than a laparoscopic cholecystectomy. You may be in the hospital for a week and return to normal activities after a month.

Extended Cholecystectomy

For gallbladder cancer, surgeons perform a more extensive open surgery called an extended cholecystectomy. It is also referred to as a radical cholecystectomy.

During an extended cholecystectomy, a surgeon will remove the gallbladder, some of the liver tissue near the gallbladder, and any nearby lymph nodes.

Sometimes, more tissues are removed depending on how far the cancer has spread. For example, the common bile duct, pancreas, or part of the liver may be removed. Radiation and chemotherapy may also be used to treat gallbladder cancer.

A laparoscopic cholecystectomy is not generally used to treat gallbladder cancer because there is a risk that some of the cancer will be missed. Moreover, there has been concern about the risk of "seeding" or spreading the cancer to other parts of the body during gallbladder removal.

Advances in laparoscopic surgery and added precautionary measures have been shown to reduce the chances of seeding. However, for treating gallbladder cancer, surgeons still generally perform an extended cholecystectomy.

Surgical Risks and Side Effects

As with any surgery, there are risks involved, which may include:

• Bleeding
• Incision site infection
• Blood clots
• Pneumonia
• Complications from anesthesia

Your healthcare provider will monitor you to make sure these effects are addressed promptly and appropriately.

Even though it's safe and OK to live without a gallbladder, some people experience gas, bloating, and diarrhea after gallbladder removal. While this is generally temporary, it may persist for years in some people.

There may be more serious side effects from an extended cholecystectomy for gallbladder cancer. These can include digestive or eating problems, bile spillage into the abdomen, or liver failure. Rest assured that your healthcare provider will monitor and address these risks.

Percutaneous Removal

If you are considered at high risk for surgery, you may undergo a series of drainage procedures to clear any obstructing stones.

With percutaneous stone removal, a very thin tube called a catheter is inserted through the skin and into the gallbladder to allow for bile drainage. The bile drains through a drainage bulb connected to the end of the catheter.

Then, over the next few weeks, the hole through which the catheter was placed is gradually enlarged, allowing for the stones to be removed.

Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is a non-surgical procedure that can be used to treat gallstones. This procedure is performed under sedation and uses shock waves to break up gallstones into tiny pieces. They can then dissolve and drain out of the gallbladder.

ERCP

A procedure called an endoscopic retrograde cholangiopancreatography (ERCP) allows a medical professional to check the bile ducts for any abnormalities like an obstructing gallstone, cyst, or tumor.

An ERCP is a procedure done to relieve an obstruction of a bile duct, most commonly from a stone.

During an ERCP, a gastroenterologist will guide a thin, flexible tube that has a tiny camera on the end of it (called an endoscope) down the mouth into the stomach and small intestine. A contrast dye is then injected through the tube to visualize the bile ducts on X-ray. 

In addition to providing a diagnosis, an ERCP is also therapeutic. This means a healthcare provider can treat the condition at the same time. For the most part, ERCP has replaced surgery for the treatment of bile duct problems in patients.

If an obstruction is seen, the gastroenterologist may use special instruments inserted through the endoscope to remove or ease the blockage. For instance, the healthcare provider may remove a stone that is obstructing the common bile duct or place a stent if the duct is narrowed.

You'll be sedated during an ERCP to prevent any discomfort and to ensure you're relaxed. While an ERCP is generally a safe and well-tolerated procedure, you may experience a mild sore throat or bloating after the procedure.

Uncommonly, ERCP-related complications may occur, including:

• Pancreatitis, which is usually mild, but will require a short hospital stay for fluids and pain management
• A hole in the intestine (called a perforation), which is rare and serious, and requires surgery to repair
• Infection of the bile ducts (called cholangitis), which requires a hospital stay for antibiotics and drainage of excess fluid
• Aspiration pneumonia, caused by accidentally inhaling food or other substances in the lungs. To prevent this, it's important to not eat or drink for several hours before the procedure.

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Prescriptions

Medications aren't usually used to get rid of gallstones. In some cases where surgery isn't recommended, healthcare providers may prescribe medicine to dissolve cholesterol gallstones. However, it can take a long time for pills to break up gallstones, and there's a chance the stones may return.

If you're experiencing pain, your healthcare provider may prescribe medications to help manage symptoms.

Managing Pain

The most common symptom of gallbladder disease is pain, usually in the upper right side of the abdomen. Your practitioner may treat your pain with a nonsteroidal anti-inflammatory drug (NSAID), such as diclofenac or ketoprofen, or an opioid like morphine.

It's important to note that opioids often make people sleepy and commonly cause constipation. Your healthcare provider may recommend taking a laxative along with your pain pill.

Dissolving Gallstones

A bile acid pill such as Actigall (ursodiol) can be taken to break down cholesterol gallstones. These are the most common type of gallstone in the United States.

While this pill is generally well tolerated, some people develop mild diarrhea, although it usually goes away with time.

A downside of taking a bile acid pill is that it can take many years for the gallstones to fully dissolve. Therefore, a bile acid pill is not a good option for people with recurrent gallstone attacks.

Antibiotics

If you have an infection of the gallbladder or of the biliary tract (a complication of gallstones), you'll need antibiotics. These will be given in the hospital along with fluids and pain control. Often, this is followed by a definitive treatment such as surgery, a drainage procedure, or an ERCP.

Complementary and Alternative Medicine

While gallbladder disease must be treated by a healthcare provider, some people also consider complementary therapies. These should not replace traditional treatment but may be used along with your healthcare provider's guidance.

It's important not to take any herbs or other supplements without checking with your healthcare provider first. Some may cause side effects or interactions with different medications.

Herbs

Certain herbs like silymarin (Silybum marianum), also called milk thistle, may provide both gallbladder and liver support. However, evidence is limited for its effects on gallstones.

Other studies have found that Lysimachiae herba, also called gold coin grass, may help prevent cholesterol gallstones. More research is needed to support these claims.

Acupuncture

Acupuncture has been found in studies to help relieve pain from gallbladder disease. However, the research is limited showing its effectiveness in getting rid of gallstones.

Lifestyle

While lifestyle changes can't treat gallbladder diseases, they may help to prevent them. If you have gallstones without any symptoms, a healthy lifestyle may help keep them from becoming symptomatic.

A sedentary lifestyle and health conditions like diabetes, obesity, and metabolic syndrome are associated with gallbladder disease, particularly the formation of gallstones.

Adopting a gallbladder-friendly diet may help prevent further gallbladder attacks. A gallbladder-friendly diet includes plenty of fiber and is rich in fruits, vegetables, and whole grains.

Healthy fats, such as fish oil and olive oil, can help the gallbladder contract and empty more efficiently. Healthy proteins like lean meats, fish, tofu, or beans are preferable to fatty red meat.

As an aside, if you are overweight or obese and are embarking on a weight loss regimen, be sure to do it under the guidance of your healthcare provider, as rapid weight loss increases your risk of gallstone formation.

Summary

Gallbladder disease, particularly gallstones, may be treated with medication, surgery, or other specialist-driven procedures.

A cholecystectomy, surgical removal of the gallbladder, is the most common treatment for gallstones that are causing symptoms. Other non-surgical procedures to remove gallstones include percutaneous removal, ESWL, and ERCP.

Your healthcare provider may prescribe medications to break up the stones, but it can take years for them to completely dissolve. Lifestyle changes, such as a healthy diet, exercise, and staying at a healthy weight, can help to support gallbladder health.

A Word From Verywell

When treating gallbladder disease, several options are available. Surgery is usually considered the most effective treatment, but non-surgical options may be appropriate for some cases.

Let your healthcare provider know if you're experiencing any symptoms. They can help you decide which medication or procedure is best for you to manage symptoms and treat the condition.