In recent years, with the continuous improvement of people’s living standards and the gradual strengthening of self-care awareness, health checkups have become increasingly popular, and more and more patients have been found to have hepatic hemangiomas. Due to the lack of understanding of these diseases, people often talk about “tumor” and associate hemangioma with malignant tumor, which causes unnecessary tension and concern to patients and their families. In fact, hepatic hemangioma is one of the most common benign tumors of the liver, with an incidence of 0.4% to 7.3%, and can be seen in people of all ages, but is more common in women aged 30 to 50. It is currently considered to be a congenital dilatation of blood vessels and not a true tumor. Most hepatic hemangiomas are small in size, generally less than 5 cm in diameter, but some can grow very large, and in the 1970s, Professor Wu Mengchao successfully removed a very large hepatic hemangioma weighing 18 kg, which is still the largest in the world. This is of course an exceptional case. In general, most hepatic hemangiomas grow very slowly, and many may remain asymptomatic for a long time or for life, and are only detected during a health check-up. The clinical manifestations of hepatic hemangioma are not specific and are often related to the location and size of the tumor growth. If the tumor enlarges and presses normal liver tissue, it may cause stuffiness or pain in the liver area; if it presses adjacent organs such as gastrointestinal tract, it may cause abdominal distension, loss of appetite, nausea, vomiting and other digestive symptoms. Some patients may also develop anemia, thrombocytopenia, and coagulation dysfunction due to rapid growth of the tumor, but these symptoms are extremely rare. With the improvement of various diagnostic imaging techniques, hepatic hemangiomas can be easily detected and the diagnosis can be basically confirmed by relying on ultrasound and CT examination. In the past, not only patients but also some clinicians were not sufficiently aware of this disease, fearing cancerous tumor or rupture, which led to strong anxiety in patients, and often the impact of this anxiety on health far exceeded that of the hemangioma itself. With the increasing understanding of this disease in recent years, such concerns are now considered unnecessary. As mentioned earlier, hepatic hemangioma is not a real tumor, and no cancer has been reported yet; at the same time, the chance of rupture of hemangioma is extremely small, with less than 40 cases of hemangioma rupture reported in the domestic and international literature since 1898, and most of the cases are traumatic or medically induced rupture, with few reports of spontaneous rupture. For the treatment of such benign occupying lesions, the aim is to relieve the symptoms. So, is it necessary to treat abdominal pain once it is present? Our answer is no. The clinical symptoms of hepatic hemangioma are not typical, and diseases such as ischemic heart disease, peptic ulcer, cholecystitis, and skeletal muscle disorder may cause similar symptoms, while some patients may also have abdominal pain symptoms due to excessive mental burden, so it is difficult to clarify the causal relationship between symptoms and hepatic hemangioma in clinical practice. Moreover, a survey also found that about 50% of patients with hepatic hemangioma still have abdominal pain symptoms after surgery, even more significantly than before surgery. Therefore, for such patients, other diseases should be investigated first, and psychological guidance and appropriate analgesic treatment should be provided, rather than blindly choosing surgical treatment. Of course, if the patient presents with anemia, thrombocytopenia, and coagulation dysfunction, it is a clear indication for surgery. Nowadays, it is a common opinion in academic circles that patients with tumor diameter less than 5 cm and no obvious discomfort in the liver area may not need any special treatment, but they should be monitored by ultrasound or CT regularly according to the doctor’s orders. Clinically, we often encounter patients who ask the question: My hepatic hemangioma is only 5cm in diameter, so it is relatively easy to remove it now, but if it is not removed now, if it grows to be more than 10cm in diameter in the future, won’t it make the operation more difficult, and if the operation fails, won’t it be worth the loss? In fact, this view is also incorrect. Some scholars have observed that only 10% of patients with liver hemangioma had significantly larger hemangioma during the follow-up period, which is a relatively small percentage. Even if the tumor diameter exceeds 10 cm, it is safe to follow up and observe if it does not cause clear symptoms. In recent years, the proportion of hepatic hemangioma treated surgically in large international hepatobiliary centers is less than 5%. The current consensus is that it is not advisable to treat this type of disease aggressively, but rather to observe it closely and to control the indications for surgery very strictly. In 1898, Hermann first reported surgical resection for hepatic hemangioma, and it is still the most thorough and effective treatment. There are two main types of surgical resection for hepatic hemangiomas: hepatic hemangioma dissection and anatomical hepatectomy. Hepatic hemangioma swells and grows, pushing and compressing the surrounding normal liver tissues, bile ducts, and blood vessels to form a lax gap, and this gap is searched for during surgery so that the hemangioma can be removed completely. This procedure can reduce the amount of bleeding and postoperative complications and maximize the preservation of normal liver tissue. Of course, hemangioma debulking has its limitations. If the tumor is multiple and confined to one liver segment, anatomical hepatectomy should be considered for complete removal of the lesion. In recent years, with the dramatic improvement in the concept, technique and equipment of liver surgery, hepatic hemangioma resection has become a very routine and safe treatment modality. Currently, domestic and international literature reports that the operative mortality rate for hepatic hemangioma resection in patients with a tumor diameter greater than 10 cm is 0% to 1%, and the complication rate is about 5% to 10%. In China, hepatobiliary specialties in large general hospitals are generally capable of performing this type of surgery. In addition to surgery, a variety of minimally invasive methods such as hepatic artery embolization, percutaneous liver puncture radiofrequency ablation or microwave curing have been carried out clinically for treatment. Although these methods have the advantage of being less invasive, their treatment still has risks and the overall effect is still to be further evaluated, and they are not recommended yet.