Is surgery required for an 18mm gallstone?

Generally, whether an 18mm gallstone requires surgery depends on the presence of symptoms and the risk of complications. An 18mm gallstone that causes symptoms or poses a risk of complications usually requires surgical intervention, whereas asymptomatic cases without complication risks can be managed conservatively with regular monitoring. The detailed analysis is as follows:

If an 18mm gallstone causes recurrent right upper quadrant pain, nausea, vomiting, or complications such as cholecystitis or bile duct obstruction, timely surgical treatment is necessary. Due to its relatively large size, an 18mm stone is more likely to block the cystic duct or bile ducts, worsening inflammation and potentially leading to more serious conditions. Surgery can remove the affected tissue, relieve symptoms, and reduce associated risks.

If an 18mm gallstone causes no discomfort and imaging shows normal gallbladder function without signs of inflammation or obstruction, surgery may be postponed. However, ultrasound examinations should be performed every 6–12 months to monitor the size of the stone and the condition of the gallbladder. If the stone grows, gallbladder function becomes impaired, or symptoms develop, the need for surgery should be promptly reassessed.

In daily care, a low-fat diet is recommended. Avoid fried foods and fatty meats to reduce the likelihood of gallbladder contractions triggering discomfort. Additionally, strictly adhere to the follow-up schedule to stay informed about disease progression.