Can Gallstones Be Treated Without Surgery? Options & Limitations

Non-surgical gallstone options: 1) UDCA (Ursodeoxycholic acid) — dissolves small cholesterol stones (<5mm), radiolucent, functioning gallbladder. Works in only 30-40% of eligible patients, takes 12-24 months, 50% recurrence within 5 years of stopping, does not prevent complications during treatment. 2) Dietary management — avoiding fatty foods reduces attack frequency but does not treat stones; useful short-term while awaiting surgery. 3) Watchful waiting — appropriate for asymptomatic gallstones (80% never develop symptoms); not appropriate for symptomatic stones, large stones >3cm, porcelain gallbladder, polyps >10mm, haemolytic anaemia. 4) ESWL — largely abandoned due to stone fragment recurrence and high recurrence rate. Why surgery remains gold standard: laparoscopic cholecystectomy permanently removes gallbladder and all stones, prevents all complications, minimally invasive (same-day discharge, 1-week recovery), <1% complication rate, cost-effective (one-time vs years of medication). Benefits of surgery far outweigh risks for most symptomatic patients.