“I don’t want surgery for my gallstones…there must be another way…”

GallstonesSurgeryHealthAbdominal pain
Written By Lalin Navaratne

I complete over 1000 consultations a year in my clinics and many of these for gallstones. I get asked this question very frequently from patients who suffer with symptomatic gallstones. Of course, why would you want to have surgery if you don’t have to! In this short post, I am going to try to dispel the myths about dissolution (using medications to breakdown and dissolve gallstones) and shockwave lithotripsy (commonly referred to as ‘laser’ therapy) for gallstone disease.

A medication called ursodeoxycholic acid (UDCA) can be effective at dissolving cholesterol gallstones, but its effectiveness depends on several factors:

  • Success Rate: UDCA can dissolve gallstones in about 30% of appropriately selected patients

  • Timeframe: Dissolution typically takes 6 months to 2 years

  • Stone Type: Only cholesterol-rich stones respond well; pigment stones do not dissolve

  • Stone Size: Best for small (<10 mm), non-calcified stones

  • Gallbladder Function: Requires a functioning gallbladder which can empty its contents into the common bile duct (i.e., the cystic duct must be patent)

This sounds good I hear you say…but what are the limitations of this treatment?

  • Recurrence Rate: Over 50% of patients develop new stones within 5 years after stopping treatment

  • Slow Response: May take many months; not suitable for acute symptoms or large stones

  • Incomplete Dissolution: Even in ideal cases, complete dissolution is not guaranteed

  • Not for Acute Cholecystitis: It’s not a treatment for inflammation or infection

So who are the ideal candidates for this medication?

  • Symptomatic patients who refuse or cannot undergo surgery

  • Patients with small, radiolucent, cholesterol-rich stones

  • Normal gallbladder function confirmed by imaging (e.g., oral cholecystography or HIDA scan)

What is the clinical evidence for this type of treatment? Studies show variable dissolution rates:

  • Small stones (<5 mm): ~50% success

  • Medium stones (5–10 mm): ~20-30% success

  • Large stones (>10 mm): Poor response

What are the alternatives to medication?

  • Surgery (laparoscopic cholecystectomy): The gold standard for symptomatic gallstones.

  • Shockwave lithotripsy: Occasionally combined with UDCA for certain patients.

In summary, ursodeoxycholic acid (UDCA) is moderately effective for dissolving small, cholesterol-rich gallstones in well-selected patients, particularly when surgery is not an option. However, due to slow action, incomplete response, and high recurrence, it is not a substitute for cholecystectomy in most symptomatic patients.

Shockwave lithotripsy (SWL) for gallstones can be effective in select patients, but its use is limited and rarely first-line today. It involves using focused acoustic pulses to break gallstones into smaller fragments, which can then pass more easily or be dissolved with medications like ursodeoxycholic acid (UDCA).

How effective is shockwave therapy?

  • Success Rate (Fragmentation): SWL can fragment gallstones in up to 60% of properly selected patients

  • Complete Clearance (with/without UDCA): Less than 30% achieve full clearance of fragments

  • Timeframe: Several weeks to months; often combined with UDCA to help dissolve fragments

Who are the best candidates for shockwave treatment?

  • Patients who have 1–3 radiolucent (low in calcium) stones only

  • Stones <2 cm

  • Patients who have a functioning gallbladder (so that fragments can be expelled from the gallbladder)

  • The duct that connects the gallbladder to the bile duct must be open to allow fragments to pass (patent cystic duct)

What are the limitations and drawbacks of this treatment?

  • Recurrence Rate: Over 50% recurrence within 5 years, similar to UDCA alone

  • Availability: Very limited — not widely offered in most clinical centers today. Surgery to remove the gallbladder has taken over as the gold standard treatment for symptomatic gallstones

  • Side Effects: Pain from stone fragments moving, biliary colic, risk of pancreatitis (inflammation of the pancreas - a very serious condition) or cholecystitis (inflammation of the gallbladder often resulting in hospitalization)

  • Incomplete Clearance: Fragments may not fully pass or dissolve, requiring follow-up treatment or surgery

  • Not Effective for:

    • Pigment stones

    • Multiple or calcified stones

    • Non-functioning gallbladder

There is an increased risk of pancreatitis with shockwave lithotripsy (SWL) for gallstones — primarily due to stone fragments passing into the common bile duct (CBD) and potentially obstructing the pancreatic duct or ampulla of Vater. Other serious complications of SWL include biliary colic (pain from fragments), cholangitis (if infection/sepsis follows bile duct obstruction from fragments), jaundice and need for further procedures such as ERCP (endoscopy)

In summary, shockwave lithotripsy can be moderately effective at fragmenting gallstones, especially when combined with ursodeoxycholic acid, but its use is highly restricted to select cases. Due to recurrence, incomplete clearance, and limited availability, it is not commonly used today — laparoscopic cholecystectomy remains the gold standard for symptomatic gallstones.

Please feel free to contact our office should you wish to make an appointment to explore all treatment options for your gallstones.

Lalin Navaratne
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