Gallstones may be treated in several different ways. People with gallstones who experience no symptoms (silent gallstones) typically do not receive treatment. Though people with silent gallstones may experience symptoms at some point in their lives, it is widely believed that the risks associated with treating gallstones outweigh the potential risk of a future gallbladder attack.

For patients with gallstones located in the gallbladder, treatment involves surgical removal of the gallbladder (cholecystectomy). Although the gallbladder plays an important role in digestion, it is not vital for survival. After it is removed, bile flows from the liver through the hepatic ducts, into the common bile duct and directly into the small intestine, instead of being stored in the gallbladder. Removing the gallbladder may have little impact on digestion and does not usually require a change in diet. However, in a small percentage of patients, it produces mild symptoms, such as loose stools, gas and bloating.

Cholecystectomy is a safe and common procedure that may be performed as open surgery or as a less invasive laparoscopy.  About 80 percent of the gallbladder surgeries performed are now laparoscopic procedures, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

During a laparoscopic cholecystectomy, four or five very small incisions are made in the abdomen and a tiny video camera and surgical instruments are inserted. Video pictures are displayed in the operating room and the gallbladder is removed with the surgical instruments. Because the abdominal muscles are not cut during this procedure, there is less pain following surgery, a shorter hospital stay (sometimes less than a day), faster recovery time and less noticeable scars. Laparoscopic procedures occasionally damage the bile ducts.

Open cholecystectomy may be performed for more complicated surgeries, such as those where infection or a large amount of scar tissue is present. An incision several inches long is made in the abdomen and the gallbladder is removed. The surgery usually requires a three-to-five-day hospital stay followed by several weeks of recuperation at home. The most common complication of cholecystectomy is injury to the bile ducts, although it is rare. Injury can cause bile to leak and result in infection. Minor injuries may be treated with non-surgical methods, but more severe injuries typically require surgical reparation.

Patients who have gallstones in the bile ducts may be treated with surgery to remove them or with endoscopic retrograde cholangiopancreatography (ERCP). This procedure involves inserting an endoscope (lighted tube) through the mouth to the small intestine. A dye is passed through a thin, flexible tube (catheter) inside the endoscope and x-rays are taken.

Gallstones can be removed during an ERCP. An instrument is passed through the endoscope and used to cut the lower bile duct where it joins the duodenum (the first part of the small intestine). One of several instruments may be used to remove the gallstones through the endoscope.

When surgery is not the best option, a patient may be treated with a non-surgical technique. They include:

• Oral dissolution therapy. Medications that contain a natural bile acid are used to dissolve cholesterol gallstones slowly over time. Although they are safe and well-tolerated medications, they can only be used in patients with small gallstones. Most patients need to take the medication for months or years for treatment to be effective.
  
  
• Extracorporeal shock wave lithotripsy (ESWL) This treatment involves the use of high frequency sound waves to break up gallstones. Oral dissolution medication is then taken to dissolve gallstone fragments. This treatment technique is not typically used for patients with more than one stone or a large stone. It is associated with a low success rate and a large degree of pain. ESWL is more commonly used and more effective in treating kidney stones. There is concern about gallstone fragments blocking the bile ducts and ERCP may be performed in association with ESWL.
  
  
• Contact dissolution therapy. This experimental treatment technique involves injecting a medication directly into the gallbladder to dissolve gallstones. It is still in the investigational stages in the United States.

The biggest disadvantage of treating gallstones with a non-surgical technique is that gallstones tend to recur because the gallbladder was not removed. Recurring gallstones may require future treatment.