Contemporary “cholecystectomy”, the predecessor of open cholecystotomy, is a procedure with a long history, which has been used as a surgical procedure for gallbladder stones as early as 1882 before langenbuch, a famous German surgeon, completed the first cholecystectomy. However, the high recurrence rate of 79.88% of stones after this procedure made it obsolete after the invention of cholecystectomy by Langenbuch became popular, and open cholecystectomy was later used only for acute septic cholecystitis, cholecystostomy, and elective cholecystectomy. In recent years, due to the popularity of minimally invasive means, especially laparoscopy and choledochoscopy have been widely used in biliary surgery. In 1992, several foreign scholars first reported 34 cases of combined choledochoscopic and laparoscopic cholecystotomy1 (Laparoscopic cholecystotomy (LCT), which has the same connotation as the “minimally invasive cholecystectomy” later promoted in China). In 2002, a landmark publication was published in China, and the author of the most frequently used literature in the field of cholecystectomy was Prof. Zhang Baoshan of Peking University Hospital No. 1 in China, in his expert lecture for the Chinese Journal of Endoscopy, Volume 8, Issue 7. In his expert lecture for the seventh issue of the Chinese Journal of Endoscopy, he mentioned the results of 895 endoscopic invasive biliary lithotripsy cases performed in several hospitals in Beijing, and concluded that the recurrence rate of stones 1-6 years after surgery was 2.7%-4.1%. The strong psychological demand of patients to preserve their body organs has been actively advocated by some clinical experts in China, which has led to a booming trend and has been highly appreciated by patients, and even patients’ enthusiasm for biliary preservation has exceeded that of experts. However, since this type of surgery still has a certain recurrence rate of stones, the cumulative 10-year recurrence rate reported in the Chinese Journal of Surgery in 1999 was about 10%.3 In a 1997 report in Hepatology, an international authoritative journal in the field of hepatobiliary, 50 patients were followed up for biliary lithotripsy, and the overall recurrence rate was about 20% within 1-5 years.4 Compared with cholecystectomy The reason is that approximately 20-40% of the gallbladder stone population is classified as quiescent gallbladder stones, which may be asymptomatic for life, without complications related to gallbladder stones, and do not require specific treatment and regular follow-up. Some patients in the community also strongly request their physicians to perform choledochotomy despite clinical guidelines. Therefore, biliary lithotripsy is still controversial and has not yet reached a consensus in the hepatobiliary community. The current situation is that although patients with such needs repeatedly seek medical consultation in the hepatobiliary surgery clinics of major hospitals, the current situation in China is that most hepatobiliary surgeons in large tertiary hospitals still take a relatively conservative attitude toward this type of surgery. In recent years, there have been few reports of biliary lithotripsy in foreign countries. However, the gallbladder stone treatment in children is an exception in foreign countries, because gallbladder stones in children are not considered to be identical to those in adults. Cholecystectomy remains a niche procedure performed on a small scale compared to the vast number of cholecystectomies performed worldwide each year, and cholecystectomy remains the accepted “gold standard” for the treatment of symptomatic gallbladder stones. In terms of technical difficulty, biliary lithotripsy does not require dissection of the gallbladder triangle and dissection of the cystic duct and gallbladder artery, so it can be performed in hospitals with the appropriate hardware and technology, and is generally less difficult and risky than cholecystectomy. At present, the academic debate focuses on: 1. The recurrence of stones after surgery: Generally speaking, the causes of gallbladder stone formation are multifaceted, largely related to chronic inflammation of the gallbladder, reduced contractile function of the gallbladder, bile metabolism and changes in the patient’s age and hormone level, and the patient’s diet and lifestyle. The possibility of recurrence remains high if the above-mentioned causative factors of the gallbladder or the body itself are not eliminated. At present, it is believed that for simple cholesterol stones in the gallbladder, postoperative oral ursodeoxycholic acid can reduce the risk of stone recurrence.4 2. The contradiction between gallbladder preservation and gallbladder removal: At present, gallbladder preservation propaganda mostly emphasizes the importance of gallbladder preservation and the danger of gallbladder removal, but it should be recognized that some gallbladders must be removed. It is true that removing a healthy and functional organ is something that surgeons need to avoid, but preserving an organ with organic lesions, such as irreversible chronic inflammation and precancerous lesions, is also something that surgeons need to try to avoid. As for the above-mentioned pros and cons, the current literature on biliary stone extraction is mostly retrospective case studies, descriptive studies, symposiums, and experience sharing, but there is still a lack of high-quality medium- and long-term follow-up reports with high follow-up rates, and there are no key data from prospective multicenter randomized controlled clinical studies in China and abroad. Therefore, it is difficult to give a convincing answer to these questions. So, should biliary surgeons perform biliary preservation surgery in the current situation? I think the strategy should be based on individualized patient assessment, with a rigorous scientific attitude and an open mind, to grasp the indications and gradually accumulate more experience. We also expect the academic community to unify the indications, surgical modalities, follow-up criteria and statistical standards for biliary stone extraction as soon as possible, and strive to achieve long-term follow-up of more than 10 years for large cases and make a convincing and high-quality RCT study. And patients should decide whether to preserve gallbladder or not after a series of evaluation of gallbladder function and pattern. For children and young adults, I personally prefer more biliary surgery if biliary preservation is appropriate, while for middle-aged and older adults, I still prefer to have the gallbladder removed for insurance purposes. Some of the indications and contraindications listed below are not conclusive and are personal opinions for reference only. There is no universally accepted indication for cholecystectomy, and it is not yet included in the guidelines and routines of gallbladder stone treatment.