Gallstones are one of the post-bariatric complications that doesn’t get nearly enough attention in pre-operative information sessions – despite being one of the more common ones. If you’ve had or are considering gastric sleeve surgery, understanding the gallstone risk is genuinely worth knowing before you’re dealing with symptoms.
Why rapid weight loss causes gallstones
The gallbladder stores bile, which the liver produces to help digest fats. During rapid weight loss, the liver processes and excretes more cholesterol than usual – and that excess cholesterol can crystallise in the gallbladder, forming stones.
The rate of weight loss is a significant factor. The faster weight is lost, the higher the risk. Given that gastric sleeve can produce very rapid weight loss in the first six to twelve months – James lost over 12 stone in his first year – it’s no surprise that gallstone development is a recognised post-bariatric complication. Published estimates suggest that up to 30-40% of patients who undergo rapid weight loss of any kind (not just bariatric surgery) develop gallstones, with a significant proportion eventually becoming symptomatic.
What the symptoms look like
Gallstones can be entirely silent – present but causing no symptoms – or they can cause significant pain, particularly after eating fatty meals. The classic symptom is biliary colic: a sharp, cramping pain in the upper right abdomen or centre of the abdomen, sometimes radiating to the back or right shoulder. It typically comes on 30 minutes to two hours after eating and can last anywhere from minutes to several hours.
More serious complications occur if a gallstone blocks the bile duct. Symptoms that warrant prompt medical attention include severe, persistent abdominal pain, fever and chills (suggesting infection – cholangitis or cholecystitis), jaundice (yellowing of the skin or whites of the eyes), and dark urine or pale stools. These are not symptoms to manage at home.
Our experience
Neither of us developed symptomatic gallstones – we were fortunate in that respect. But it’s something we were made aware of by our bariatric team before surgery, and it’s something we’ve heard about from people in our post-op support groups who weren’t warned and were consequently blindsided by gallbladder problems in their first year.
Some bariatric surgeons and clinics proactively prescribe ursodeoxycholic acid (a medication that reduces bile cholesterol concentration and lowers gallstone formation risk) for the first six months post-op. This isn’t universal practice, but if your clinic doesn’t mention it, it’s worth asking about. The evidence for its effectiveness in the bariatric context is reasonable and the medication is well-tolerated.
Treatment
If gallstones become symptomatic, the standard treatment is surgical removal of the gallbladder (cholecystectomy). This is typically done laparoscopically, is well-established, and most people recover without ongoing digestive problems. You can live without a gallbladder – the liver continues to produce bile, which drains directly into the small intestine. Some people notice looser stools or digestive sensitivity to fatty foods in the months following removal, but this generally settles.
The timing relative to bariatric surgery matters. If you develop symptomatic gallstones soon after sleeve surgery, while you’re still in the early recovery phase, your surgical team will advise on the appropriate timing and approach for cholecystectomy.
What to do with this information
You can’t entirely prevent gallstone formation during rapid weight loss – some cholesterol supersaturation is a physiological consequence of the process. What you can do is avoid dietary extremes that increase the risk further. Maintaining some fat in your diet (rather than going fully fat-free) keeps bile moving regularly and reduces the chance of cholesterol crystallising. Eating regularly rather than skipping meals has the same effect.
If you develop any of the symptoms described above, don’t dismiss them as general post-op digestive discomfort. Gallbladder pain has a fairly distinctive character and location. See your GP, mention your bariatric surgery history, and ask for an ultrasound if symptoms persist.
Sources cited in this post: NHS – Gallstones: causes, symptoms and treatment
NICE CG188 – Gallstone disease: diagnosis and initial management
BOMSS – Post-operative guidelines for bariatric patients (rapid weight loss and gallstone risk)
NHS – Obesity and its effects on the body
- NHS, “Weight loss surgery”: https://www.nhs.uk/conditions/weight-loss-surgery/
- British Obesity & Metabolic Surgery Society (BOMSS): https://bomss.org/
About this content
This blog is written by James and Kirsten, a couple from the UK who had gastric sleeve surgery together in March 2024.
We started this blog because we couldn't find any sources of content that details before surgery, the surgery and then life post surgery - so we decided to write one ourselves.
Everything on this site is based on our own experience and the research we have done along the way. It is not medical advice. Gastric sleeve surgery is a serious procedure and every patient's journey is different. Please always consult your own bariatric team or GP before making any decisions about your health or treatment.
Some posts on this site may contain featured or sponsored content, or affiliate links. Where this is the case, it will always be clearly stated at the top of the article. Our opinions are always our own.
Publish Date: 12 February 2026 | Last Reviewed: 27 June 2026 | Next Planned Review: 27 December 2027