Understanding Gallstones
Gallstones are hardened deposits of digestive fluid (bile) that form in the gallbladder. They range in size from a grain of sand to a golf ball and can number from one to hundreds. Most are cholesterol stones (80%) or pigment stones (from haemolysis or infection). Singapore has a high prevalence of gallstones due to the local diet — approximately 10–15% of adults are affected.
From Silent Stones to Complications
| Condition | Features | Management |
|---|---|---|
| Silent gallstones | No symptoms; found incidentally on scan | Observation; no immediate surgery required |
| Biliary colic | Episodic right upper quadrant pain after fatty meals; no infection | Elective laparoscopic cholecystectomy |
| Acute cholecystitis | Gallbladder inflammation/infection; fever, persistent pain, Murphy's sign | Semi-urgent or urgent cholecystectomy; IV antibiotics |
| Choledocholithiasis | Stones in the common bile duct; jaundice, dark urine, pale stools | ERCP to clear duct + cholecystectomy |
| Cholangitis | Bile duct infection; Charcot's triad (fever, jaundice, RUQ pain) | Urgent ERCP + IV antibiotics — medical emergency |
| Gallstone pancreatitis | Stone obstructs pancreatic duct outlet; severe upper abdominal pain radiating to back | Hospitalisation; ERCP if bile duct stone; cholecystectomy same admission |
Laparoscopic Cholecystectomy — Step by Step
- General anaesthesia administered
- 4 small incisions (0.5–1.2cm) made in the abdomen
- COâ‚‚ gas inflates the abdomen; camera and instruments inserted
- Gallbladder carefully dissected from liver bed; cystic duct and artery clipped and divided
- Gallbladder removed through the navel incision in a bag
- Incisions closed; patient recovers for 1–2 hours
- Same-day discharge or 1-night stay
Conversion to open surgery is needed in approximately 3–5% of cases — typically due to severe inflammation or unexpected anatomy. This is not a complication but a clinical decision to ensure safety.
See our researched shortlist: subspecialty focus, credentials and clinic websites, checked against public records.
View the shortlist →Gallstones form when bile becomes supersaturated with cholesterol or bilirubin. Risk factors (the 5 Fs): Female, Forty (and above), Fat (obese/overweight), Fertile (multiple pregnancies), and Fair (Western diet). Additional risks include rapid weight loss, diabetes, haemolytic anaemia, and certain medications. Singapore's rich, high-fat diet and rising obesity rates make gallstones increasingly common.
No. Silent gallstones (discovered incidentally without symptoms) in otherwise healthy adults can be observed. Annual symptomatic risk is approximately 1–4%. Surgery is indicated for: symptomatic gallstones (biliary colic), acute cholecystitis, gallstone pancreatitis, and choledocholithiasis (stones in the bile duct). Diabetics with gallstones are often advised earlier surgery due to higher complication risk.
Biliary colic is characteristically a severe, cramping pain in the right upper abdomen or epigastrium, often radiating to the right shoulder or back, lasting 30 minutes to several hours. It typically occurs after fatty meals. Between attacks, there is no pain. Acute cholecystitis (infected/inflamed gallbladder) causes persistent right upper quadrant pain with fever and tenderness — this is more serious.
Laparoscopic cholecystectomy (keyhole gallbladder removal) at a private hospital: $7,000–$15,000. Open cholecystectomy (rarely needed): $8,000–$18,000. ERCP (for bile duct stones): $3,000–$8,000 at private centres. All procedures are Medisave and MediShield Life claimable. Public hospital subsidised rates are significantly lower.
ERCP (Endoscopic Retrograde Cholangiopancreatography) is an endoscopic procedure that accesses the bile duct through the duodenum to remove stones, place stents, or diagnose bile duct pathology. It is performed when gallstones have migrated into the common bile duct (choledocholithiasis), causing jaundice, cholangitis (bile duct infection — a serious condition), or pancreatitis. ERCP is usually performed before or alongside laparoscopic cholecystectomy.