How are gallstones removed?
Nov 05, 2025
Source: Cainiu Health
Dr. Huang Yuhong
Introduction
Treatment methods for gallstones typically include laparoscopic cholecystectomy, open cholecystomy, endoscopic sphincterotomy for stone removal, percutaneous transhepatic cholangioscopic lithotomy, and medical dissolution therapy. Laparoscopic cholecystectomy involves making several small incisions in the abdomen to insert a laparoscope and surgical instruments to remove the gallbladder containing the stones, thereby completely eliminating the gallstones.
Methods for removing or managing gallstones generally include laparoscopic cholecystectomy, open cholecystectomy, endoscopic sphincterotomy with stone extraction, percutaneous transhepatic cholangioscopic lithotripsy, and medical dissolution therapy. A detailed analysis is as follows:
1. Laparoscopic cholecystectomy: This procedure involves making several small incisions in the abdomen to insert a laparoscope and surgical instruments to remove the gallbladder containing the stones, thereby completely eliminating gallstones. It is minimally invasive, allows for rapid recovery, and causes less postoperative pain. It is currently the most commonly used method for treating symptomatic gallbladder stones, with most patients able to get out of bed within 1–2 days after surgery.
2. Open cholecystectomy: This approach is required when gallbladder stones are accompanied by severe inflammation, extensive adhesions between the gallbladder and surrounding tissues, or contraindications to laparoscopic surgery. The surgical incision is larger, resulting in a longer recovery period. However, it allows more direct management of complex anatomical situations and ensures surgical safety.
3. Endoscopic sphincterotomy with stone extraction: This method is suitable for bile duct stones. A duodenoscope is advanced to the opening of the bile duct, the biliary sphincter is cut, and stones are removed using a retrieval basket or balloon catheter. This technique is non-surgical, causes minimal bodily trauma, and is ideal for patients with bile duct stones who have normal gallbladder function.
4. Percutaneous transhepatic cholangioscopic lithotripsy: Used for large or complex bile duct stones, this procedure first establishes a tract through a liver puncture, then inserts a cholangioscope to directly visualize the stones. Special instruments are used to fragment and extract the stones under direct vision. This method effectively treats stones that cannot be removed via endoscopy and provides an important therapeutic option for complicated bile duct stones.
5. Medical dissolution therapy: For small, soft cholesterol stones, medications such as ursodeoxycholic acid can be administered to promote stone dissolution. This treatment requires a long duration—several months to years—and has a high recurrence rate after discontinuation. It is only suitable for selected patients who cannot tolerate surgery or do not meet surgical criteria.
Prior to selecting a stone removal method, comprehensive imaging evaluations should be performed to determine stone size, location, and gallbladder function. Regular follow-up abdominal ultrasounds are recommended to monitor for stone recurrence.
