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Gallbladder

Do I need surgery if I have gallstones but no symptoms?

Most silent gallstones stay silent. The published figures put a number on how many do not.

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Answer

Most gallstones that have never caused symptoms do not go on to cause them: a 2026 meta-analysis of 25,924 people found about 10 percent became symptomatic within five years and 19 percent within ten, and its authors recommend conservative management rather than preventive surgery for most patients.

Key takeaways

  • A 2026 systematic review of eight cohort studies covering 25,924 people found that 10 percent of those with asymptomatic gallstones developed symptoms within five years.
  • The same review found 19 percent had developed symptoms at ten years and 26 percent at fifteen years.
  • The pooled incidence rate was about two people per hundred per year.
  • Alcohol consumption and hyperlipidaemia were associated with a higher chance of developing symptoms, while smoking, diabetes and age were not.
  • The review's authors recommend conservative management for most patients with asymptomatic gallstones.

A gallstone found on a scan ordered for something else is one of the most common incidental findings in medicine. The question it raises — whether to remove a gallbladder that has never caused trouble — now has reasonably precise numbers behind it.

How many silent stones stop being silent

A systematic review and meta-analysis published in PLOS ONE in March 2026 pooled eight cohort studies covering 25,924 people whose gallstones had never caused symptoms, and followed what happened to them.

Cumulative proportion developing symptoms, pooled across eight cohorts
Time from diagnosisDeveloped symptoms95% confidence interval
5 years10%10–11%
10 years19%14–25%
15 years26%12–40%

The confidence intervals widen considerably with time, which is the honest way of saying that the five-year figure is well established and the fifteen-year figure is not. The pooled incidence rate across all follow-up was about two people per hundred per year.

19%

of people with asymptomatic gallstones had developed symptoms at ten yearsAlzoubi M et al., PLOS ONE, 2026

What happens to those who do develop symptoms

These proportions describe the minority who became symptomatic — not the whole group. Among that minority, the review recorded:

  • Biliary colic in about 60 percent — pain, without a structural complication.
  • Common bile duct stones in about 19 percent.
  • Acute cholecystitis in about 19 percent.
  • Gallstone pancreatitis in about 7 percent.
  • Obstructive jaundice in about 6 percent.
  • Gallbladder adenocarcinoma in about 3 percent.

What raises the chance

The review tested a range of characteristics against the likelihood of developing symptoms. Two were associated with higher risk, and two with lower.

Factors associated with developing symptoms
FactorRelative riskDirection
Alcohol consumption1.32Higher risk
Hyperlipidaemia1.19Higher risk
Male sex0.54Lower risk
Chronic liver disease0.76Lower risk

Smoking, diabetes, age, and having two or fewer stones showed no significant association either way — which is worth knowing, because several of these are commonly cited in consultations as reasons to operate early.

Sources

  1. 1

    Alzoubi M, Omar Saleh A, Omari FA, Shatnawi K, Hyari B, Qashou A, et al.

    Asymptomatic gallstones: Cumulative incidence proportion, incidence rate, and risk factors for symptoms development: Systematic review and meta-analysis

    PLOS ONE 2026;21(3):e0345462

    doi:10.1371/journal.pone.0345462 · PMID:41886405

    https://doi.org/10.1371/journal.pone.0345462
  2. 2

    Jeon CH, Hong J, Jung J, Moon JY, Seo HS

    Chronological trends in patients undergoing cholecystectomy in Korea: a nationwide health insurance claims study

    Annals of Surgical Treatment and Research 2022;102(4):205-213

    doi:10.4174/astr.2022.102.4.205 · PMID:35475231

    https://doi.org/10.4174/astr.2022.102.4.205