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Developing of gallstones after gallbladder removal

Cholecystectomy (gallbladder removal) is the gold standard treatment option for gallstones to avoid the recurrence of gallstones. However, developing gallstones in the common bile ducts continued even after gallbladder removal.

Key facts

  • Cholecystectomy (gallbladder removal) is considered the gold standard treatment of gallstones.
  • Studies reported the formation of gallstones in the common bile ducts continued even after gallbladder removal.
  • Incomplete gallbladder removal could be one of the main causes of gallstone formation after gallbladder removal.
  • The normal secretion of bile is continued in your liver, even after gallbladder removal, this could result in gallstone formation anywhere in your bile duct system.
  • Symptoms of gallstones after gallbladder removal are similar to those reported with gallstones. Symptoms include abdominal pain, nausea, and vomiting.
  • Bile duct stones were reported even several years following gallbladder removal.


Can you still produce gallstones after gallbladder removal?

Gallstones diseases which are considered common gastrointestinal diseases are characterized by a high rate of recurrence. A study showed that the overall recurrence rate of gallbladder stones was 9.3% with a median follow-up of 59 months.

Now, the question is, can still produce gallstones after gallbladder removal? In short, the answer is yes, you can develop gallstones even if you have removed your gallbladder.

In this case, stones are located within your common bile duct and are known as choledocholithiasis (Ref).

There are many studies showing that patients who had a cholecystectomy (removal of the gallbladder) could develop gallstones in the common bile ducts which are known as choledocholithiasis (Ref).

  • A large prospective study published in the Journal of the national library of Medicine showed that
    • Choledocholithiasis (Stones within your common bile ducts) occurs in 3.4% of patients undergoing laparoscopic cholecystectomy (Gallbladder removal).
    • Up to one-third of these patients do not require intervention because they clear their ducts of calculi spontaneously after surgery.
  • A study published in 2012 examined the recurrence of common bile duct stones in patients who had common bile duct stones removal followed by gallbladder removal. Researchers showed that:
  • The recurrence of common bile duct stones occurred in 15 of 144 patients (10.4%) during the follow-up period (5 years), and the mean period until the first recurrence was 25.9 months.
  • A recent study published in 2021 in the Journal of Gastrointestinal Endoscopy
    • Researchers reported the formation of common bile duct stones in 20.1% (56/278) of patients who had complete removal of common bile duct stones followed by cholecystectomy.
    • Also, researchers recommended that a Close follow-up should be considered in patients with high-risk factors to detect common bile duct s stones early.

What are the causes of gallstones after gallbladder removal?

Gallstones may form post-gallbladder removal owing to the following reasons:

The normal secretion of bile in your liver

Even after the gallbladder is removed, your liver normally produces bile. In the absence of a gallbladder. The secreted bile cannot be stored without a gallbladder. Therefore, gallstones can be formed anywhere along your bile duct system

Incomplete removal of the gallbladder during surgery.

Sometimes, incomplete removal of the gallbladder may result after cholecystectomy. However, the incidence of incomplete gallbladder removal following conventional cholecystectomy appears very low.

The incomplete gallbladder removal leads to residual gallbladder stones after cholecystectomy. Therefore retained stones or regeneration of stones in the remnant gallbladder could result.

This usually appears as right upper quadrant abdominal pain and dyspepsia, with or without jaundice (Ref).

Reasons for incomplete gallbladder removal include (Ref)

  • Poor visualization of gallbladder fossa (A depression lodging the gallbladder on the undersurface of the liver anteriorly, between the quadrate and the right lobes) during surgery
  • Adhesions
  • Concurrent inflammation
  • Excessive bleeding
  • Confounding gallbladder morphology such as a congenital duplication

Other possible explanations

Another possible explanation for gallstones in the bile duct after gallbladder removal may be attributed to the migration of surgical clips during surgery and its subsequent role as a nidus for stone formation, and primary choledocholithiasis (Ref).

What are the symptoms of common bile duct stones after gallbladder removal?

Patients with gallstones after gallbladder removal may have symptoms including the following (Ref)

  • Abdominal pain
  • Jaundice
  • Nausea
  • Vomiting
  • Fever
  • Cholangitis which means inflammation of your bile duct system
  • Pancreatitis
  • Elevated levels of bilirubin or liver enzymes.

Risk factors of recurrent common bile duct stones:

The risk factors for recurrent bile duct stones include (Ref)

  • Age (older than adult patients)
  • Gender (male higher than female)
  • A dilated common bile duct,
  • Presence of gallstones in presence of gallbladder
  • Delayed biliary emptying
  • Periampullary diverticulum means extraluminal outpouchings of the duodenum arising within a radius of 2-3 cm from the ampulla of Vater
  • Biliary stricture (occurs when the bile duct (the tube that takes bile from the liver to the small bowel) gets smaller or narrower).


1. Can you get gallstones 10 years after gallbladder removal?

Yes, you can get gallstones even after a long time post-gallbladder removal.

Cases of bile duct stone formation were reported more than 10 years after gallbladder removal.

  • A study showed old male patient 86 years old presented to the Emergency Department with complaints of constant abdominal pain with nausea and vomiting. After examination, the patient was diagnosed with common bile duct stones, despite the patient’s history showing cholecystectomy 10 years before this time.
  • Another study reported a case of choledocholithiasis following cholecystectomy with a latency period of 33 years. The patient (a 57-year-old African American female) was suffering from abdominal pain, nausea, vomiting, and fever. After examination, she was diagnosed with choledocholithiasis despite she had cholecystectomy for 33 years.

2. What should you avoid if you have no gallbladder?

Post-gallbladder removal you have to avoid the following foods:

  • Fat rich foods
  • Fatty meats
  • Dairy products
  • Fried foods
  • Spicy foods
  • Refined carbohydrates

3. What is the difference between choledocholithiasis and cholelithiasis?

Cholelithiasis means the presence of gallstones in the biliary tract usually in the gallbladder.

Choledocholithiasis means the presence of gallstones in the common bile duct