Gallstones can be surprisingly quiet. Then, suddenly, they aren’t.

One minute, you’re fine. The next, there’s a sharp pain under your right ribs after dinner, perhaps with nausea or vomiting, and you’re wondering whether that “small stone” seen on an ultrasound really needs surgery.

That question comes up often. And the answer isn’t simply, “You have gallstones, so remove them.” The decision depends on whether the stones are causing symptoms, whether complications have developed, and what your scans and blood tests show.

What Are Gallstones?

Gallstones are hardened deposits that form inside the gallbladder, a small organ tucked beneath the liver. They can be tiny, almost like grains of sand, or considerably larger. Some people develop a single stone; others have many.

And here’s the interesting part: not every gallstone needs to be removed.

If an ultrasound discovers gallstones incidentally and you have no symptoms, your doctor may simply recommend observation rather than rushing towards an operation. These are often called “silent” gallstones.

When Does Gallbladder Surgery Become Necessary?

Things change when the stones start causing trouble.

A typical gallbladder attack may produce intense pain in the upper-right abdomen, sometimes spreading towards the back or right shoulder. It can last for several hours and may appear after a heavy or fatty meal—often when you least expect it, such as late at night when you’re hoping to sleep.

If you’ve already experienced one genuine gallbladder attack, another episode may follow. Repeated symptoms are one of the reasons doctors commonly recommend gallbladder removal rather than simply waiting for the next attack.

Surgery becomes particularly important when gallstones cause complications such as:

• Acute inflammation of the gallbladder (cholecystitis)
• Stones blocking the common bile duct
• Jaundice caused by bile duct obstruction
• Gallstone-related pancreatitis
• Infection involving the gallbladder or bile ducts

These aren’t situations where you should keep hoping the pain will disappear on its own. A blocked bile duct, for example, can lead to serious complications and requires prompt medical assessment.

How Is Gallbladder Removal Performed?

The standard operation is called a cholecystectomy—removal of the gallbladder itself rather than simply picking out individual stones.

In many patients, this is performed laparoscopically through small incisions using a camera and specialised instruments. The gallbladder is removed, and bile continues to travel from the liver into the intestine. You can live normally without a gallbladder because it isn’t an essential organ.

But surgery isn’t something to decide from an ultrasound report alone.

A surgeon considers your symptoms, medical history, examination findings, blood tests and imaging—usually including an ultrasound—to determine whether the gallstones are actually responsible for your problem and whether surgery is appropriate.

Don’t Ignore the Warning Signs

Persistent abdominal pain deserves attention. So do fever, chills, repeated vomiting, yellowing of the eyes or skin, dark urine, or unusually pale stools.

These symptoms can indicate a complication rather than a simple episode of biliary pain. Get medical care promptly.

For patients dealing with recurrent gallstone symptoms, consultation with an experienced surgeon can make the next step much clearer. Dr Tarun Mittal evaluates gallbladder conditions and discusses appropriate surgical options based on the patient’s symptoms, investigations and overall health—not merely the number or size of stones seen on a scan.

Because the real question isn’t, “How many stones do I have?”

It’s simpler.

Do these stones need to come out?

And that answer should come from a proper clinical evaluation, not guesswork.