Your treatment plan for gallstones depends on how the symptoms are affecting your daily life. If you don't have any symptoms, active monitoring is often recommended. This means you won't receive immediate treatment, but you should let your GP know if you notice any symptoms.

As a general rule, the longer you go without symptoms, the less likely it is that your condition will get worse. You may need treatment if you have a condition that increases your risk of developing complications, such as:

• scarring of the liver (cirrhosis)
• high blood pressure inside the liver (this is known as portal hypertension and is often a complication of alcohol-related liver disease)
• diabetes

Treatment may also be recommended if a scan shows high levels of calcium inside your gallbladder, as this can lead to gallbladder cancer in later life.

If you have episodes of abdominal pain (biliary colic), treatment depends on how the pain affects your daily activities. If the pain is mild and infrequent, you may be prescribed painkillers to control further episodes and be given advice about eating a healthy diet to help control the pain.

If your symptoms are more severe and frequent, surgery to remove the gallbladder is usually recommended. The gallbladder isn't an essential organ and you can lead a normal life without one.

Keyhole surgery to remove the gallbladder

If surgery is recommended, you'll usually have keyhole surgery to remove your gallbladder. This is known as a laparoscopic cholecystectomy. During a laparoscopic cholecystectomy, 3 or 4 small cuts are made in your abdomen.

One larger cut (about 2 to 3cm) is made by the belly button and the others (each 1cm or less) will be on the right side of your abdomen.

If gallstones are found, they may be removed during keyhole surgery. If the operation can't be done this way, or an unexpected complication occurs, it may have to be converted to open surgery.

Open surgery

A laparoscopic cholecystectomy may not be recommended if you:

• are in the third trimester (the last 3 months) of pregnancy
• are extremely overweight
• have an unusual gallbladder or bile duct structure that makes a keyhole procedure difficult and potentially dangerous

In these circumstances, an open cholecystectomy may be recommended. Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time and causes more visible scarring.

Endoscopic retrograde cholangio-pancreatography (ERCP)

Endoscopic retrograde cholangio-pancreatography (ERCP) is a procedure that can be used to remove gallstones from the bile duct.

The gallbladder isn't removed during this procedure, so any stones in the gallbladder will remain unless they're removed using other surgical techniques.

ERCP is similar to a diagnostic cholangiography (see diagnosing gallstones for more information), where an endoscope (a long, thin flexible tube with a camera at the end) is passed through your mouth down to where the bile duct opens into the small intestine.

But during ERCP, the opening of the bile duct is widened with a small cut or an electrically heated wire. The bile duct stones are then removed or left to pass into your intestine and out of your body. Sometimes a small tube called a stent is permanently placed in the bile duct to help the bile and stones pass.

Diet and gallstones

In the past, people with gallstones who weren't suitable for surgery were sometimes advised to adopt a very low-fat diet to stop the gallstones growing. But recent evidence suggests this isn't helpful because rapid weight loss resulting from a very low-fat diet can actually cause gallstones to grow.

This means that if surgery isn't recommended or you want to avoid having an operation, it's advisable to adopt a healthy, balanced diet based on The Eatwell Guide. This involves eating a variety of foods, including moderate amounts of fat, and having regular meals.