Gallbladder stones, to operate or not to operate? For young patients with small stones and no symptoms, surgery can be suspended, pay attention to diet and follow up regularly. When is the appropriate time for surgery? It is generally recommended to operate when there is no pain, and for acute attacks, it is more appropriate to operate 1-2 months after the inflammation is controlled, because at that time the gallbladder is not inflamed and edematous, and the operation is simple, with quick recovery and few complications. If conservative treatment is not effective, emergency surgery is required, but the risk is much greater. Although there are units that carry out emergency laparoscopic cholecystectomy, which allows minimally invasive surgery to remove the gallbladder during acute attacks, the risk of surgery is still much higher, so minimally invasive surgery should be chosen to remove the gallbladder in the absence of inflammation. How is minimally invasive cholecystectomy done? The procedure of gallbladder removal is exactly the same for minimally invasive and open surgery. The difference is that minimally invasive has a small puncture opening in the abdominal wall, and we will remove the gallbladder in a retrieval bag. Sometimes, because of too many stones that are too large, or because of gallbladder edema, we will cut up the specimen to facilitate removal, but the gallbladder is removed to make sure it is intact, not piece by piece, and there will be no residue. Can I have my gallbladder preserved? How is biliary preservation lithotripsy done? Imaging such as ultrasound or MRI clearly shows single or few stones, and intraoperative choledochoscopy or cholecystoscopy must be clear that there are no residual stones or sediment, otherwise, stone recurrence is the biggest pain after cholecystectomy. Moreover, since cholecystitis is a risk factor for gallbladder cancer, some patients with cholecystitis have actually developed gallbladder cancer, and at this time, if gallbladder preservation and stone extraction surgery is done, the treatment time of gallbladder cancer may be delayed. Even if there is no cancer at present, if the gallbladder wall is thickened and inflammation persists, it will increase the chance of gallbladder cancer in the future. What is the difference between bile duct stones and gallbladder stones? The location of growth is different, and some of the causes are different. Some bile duct stones are gallbladder stones that fall 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 for all of them. Why is it necessary to put a drainage tube for bile duct stone surgery? Because the bile duct is the only way for the bile secreted by the liver to enter the intestine, 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 bile duct 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. Currently, the T-tube is usually left in place for 6-8 weeks, and it can be removed only after there are no strictures or stones remaining on the imaging. An alternative treatment for common bile duct stones is to locate the opening of the bile duct into the intestine via gastroduodenoscopy and retrograde cannulation to remove the stones from the bile duct. It is a better minimally invasive treatment because there is no need to incise the common bile duct and no need to leave drainage 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. How will my life be affected after gallbladder removal? The physiological function of the gallbladder is to concentrate and store bile, so a low-fat diet is required for a short period of time after gallbladder removal, otherwise diarrhea after eating may occur after surgery due to the lack of bile to aid digestion. Generally, after 2-3 months, the bile ducts will compensate for the expansion and play the role of part of the gallbladder, and then the diet can be basically normal and has no effect on life. Therefore, it is normal to find mild dilatation of bile ducts after cholecystectomy and there is no need to worry.