1, gallbladder stones, to open or not to open Young patients, stones are not large, no symptoms, can temporarily do not operate, pay attention to diet, regular follow-up review; right upper abdominal pain and discomfort, especially recurrent patients, in principle, are recommended to operate; senior patients, underlying diseases, even if asymptomatic, conditions allow it is recommended to operate as soon as possible, because once the acute attack risk is great; physical examination found to have gallbladder atrophy and other suspected If there is a risk of malignant transformation, surgery is recommended as early as possible. It is generally recommended to operate when there is no pain, and it is more appropriate to operate 1-2 months after the inflammation is controlled for acute attacks, because at this time the gallbladder is not inflamed and edematous, and the operation is simple, with fast recovery and few complications. If conservative treatment is not effective, emergency surgery is required, but the risk is much greater. 3. Minimally invasive, or open I just want to say that one is a fine operation under a high-definition magnified view many times, and the other is a deep small incision to pull out by hand, there is no doubt that laparoscopic cholecystectomy has been the international gold standard for decades. Of course, those who have difficulty operating laparoscopically still need open surgery as a supplement, and the incision must not be small at that time. Trust the doctor, not the village lady next door. 4, gallbladder removal surgery how to do, minimally invasive can open clean together with see the picture. Just to clarify, the process of gallbladder removal, minimally invasive and open surgery is exactly the same. The difference is that the minimally invasive abdominal wall puncture opening is small, we will put the gallbladder in a bag to take out, sometimes because of too many stones too large, or gallbladder edema, we will cut the specimen to facilitate removal, but the gallbladder is removed to determine the integrity, not a piece of removal, and there will be no residue. 5, I can bile preservation what biliary lithotripsy how to do B ultrasound or MRI and other imaging tests clearly single or few stones, intraoperative choledochoscopy or cholecystoscopy must be clear no residual stones or sediment, otherwise, stone recurrence is the biggest pain after biliary preservation surgery. 6. What is the difference between bile duct stones and gallbladder stones Continue to see the picture, the growth location is different and some of the etiology is different. Some of the bile duct stones are gallbladder stones falling into the bile duct through the gallbladder duct, called secondary bile duct stones, while primary bile duct stones have a higher recurrence rate. Common bile duct stones may cause bile duct obstruction and affect liver function, etc. In principle, surgery is recommended. 7.Why drainage tube should be put in bile duct stone surgery Because bile duct is the only way for bile secreted by liver to enter the intestine, so bile duct stones cannot be simply removed like gallbladder stones. When the bile duct is incised to remove the stone and then sutured, the healing process may cause biliary stricture because of the constriction of the incision, so we routinely leave a T-tube in the bile duct to prevent stricture and bile leakage. At present, the T-tube is usually left in place for 2-3 months, and it can be removed only after there is no stricture or stone residue on the imaging. 8.What is ERCP There is another treatment method for common bile duct stones. The opening of the bile duct into the intestine is found via gastroduodenoscopy, and a retrograde tube is inserted to remove the stones from the bile duct. This is an excellent minimally invasive treatment because there is no need to incise the common bile duct and no drainage is left in place. We recommend that patients with gallbladder stones combined with bile duct stones can be treated in two steps, with ERCP first to remove the bile duct stones and then laparoscopic cholecystectomy to achieve the least trauma and fastest recovery. However, the relative cost is higher and ERCP does not guarantee 100% success. 9.What is the impact of cholecystectomy on my life? The physiological function of gallbladder is to concentrate and store bile, so a low-fat diet is needed in the short term after cholecystectomy. Therefore, it is normal to find mild dilatation of bile ducts after cholecystectomy and there is no need to worry.