Cholelithiasis is a very common clinical condition, but many patients who visit our clinic or consult on our website are confused about which department they should see, sometimes surgery, sometimes laparoscopy, and sometimes gastroenterology. Let’s look at a simple diagram of the biliary system. Gallstone is not a disease, it can be divided into the following categories: 1) gallbladder stones; 2) common bile duct stones; 3) intrahepatic bile duct stones. 4) mixed stones (gallbladder stones + common bile duct stones, etc.). Therefore the treatment is different. The first situation: if there are only gallbladder stones, no common bile duct stones and intrahepatic bile duct stones, and the patient has no obvious discomfort, then most patients can be treated without treatment; however, if there are obvious symptoms of acute cholecystitis, such as abdominal pain, fever, jaundice, obvious abdominal discomfort after eating fatty food, etc., then it is difficult to keep the gallbladder; therefore, patients with gallbladder stones who To be treated surgically, it is recommended to see a general surgeon, paying special attention when consulting the surgeon and asking if laparoscopic cholecystectomy can be performed, which is less traumatic and has faster recovery. If there are only common bile duct stones, but no gallbladder stones or intrahepatic bile duct stones, it is recommended to treat them as soon as possible because the lower part of the common bile duct is the common opening of the bile duct and pancreatic duct, which is the main traffic channel of our body, and once there is a blockage here, acute cholecystitis, acute cholangitis, acute pancreatitis and other emergencies may occur. Therefore, it is recommended that endoscopic stone extraction is the first choice, which is usually done by gastroenterology or endoscopy, and some hospitals are also operated by general surgery, which is also less traumatic and faster recovery. If there is no condition, then surgical extraction is considered. The third situation: common bile duct stones combined with gallbladder stones This situation is also frequently encountered in the clinic, and there are two ways to deal with it: the first one is direct surgery with cholecystectomy + common bile duct exploration + T-tube drainage, the advantage is that it can solve both problems at once, but the cost is more traumatic, the patient’s recovery is slower, and the risk of complications from surgery cannot be ignored. The second approach is to replace one giant surgery with two minimally invasive surgeries (laparoscopic cholecystectomy and stone extraction). The benefits are obvious, that is, less trauma, faster recovery, and no obvious wounds on the body surface, but the disadvantage is mainly that the cost may be more expensive; therefore, for patients with poor financial situation, sometimes direct surgery has to be chosen. Whether laparoscopic cholecystectomy or stone extraction is performed first depends on the experience and level of the local hospital, and in most cases it is possible to do either one first.