The main problem of surgical treatment of polypoid gallbladder (PLG) is to grasp its surgical indications and surgical methods. The purpose of surgical treatment for PLG is to eliminate symptomatic PLG lesions, chronic cholecystitis and gallbladder stones, and to detect gallbladder cancer at an early stage or to prevent cancerous changes. Currently, PLG with cancer tendency are as follows: ① adenoma of gallbladder: its malignant transformation has been confirmed by many domestic and foreign research institutes, and the cancer rate is as high as 2O-3O%. Adenomyosis: characterized by the formation of RA sinus and the proliferation of surrounding fibro-smooth muscle, there are often siltation and small stones in RA sinus, and there are many reports of gallbladder cancer and gallbladder cancer occurring in RA sinus, so adenomyosis of gallbladder is also a precancerous lesion. Adenomatous hyperplasia: It is a proliferative lesion characterized by active proliferation of epithelial and mesenchymal cells to form glandular cavity-like structures. ④ Tumor risk factors: solitary, diameter >10mm, broad-based or thick tip, recent growth of lesion, age >5O years, combined with stones should be listed as high-risk patients for tumor. 2. Problems and countermeasures There are different views at home and abroad on the indications, timing and methods of surgery for this disease. There are radicals who advocate early removal of the gallbladder, which leads to a 2-fold or even 1O-fold increase in the incidence of postoperative right hemicolectomy cancer due to the removal of the normal functioning gallbladder; and there are conservatives who delay the best surgical timing, which makes the benign ones malignant. In fact, the principle of surgery should be based on the following two points: (1) relief of clinical symptoms for benign lesions; (2) early detection of malignant lesions or prevention of malignant tendency. For PLG patients, individualized treatment should be taken, mainly from the following aspects: ① polyp size 5 mm is mostly benign, and >10 mm is more likely to be malignant. The diameter of 1O~13mm tends to be adenoma. >13mm is considered as possible gallbladder cancer, especially for those aged >50 years. ② Shape: papillary shape is mostly benign, irregular shape is mostly malignant. Those with long and thin tips are more likely to be benign; those with thick and wide bases are more likely to be malignant. ⑧Number: multifidus is often cholesterol polyp, and solitary is often adenoma or carcinoma. ④Site: body malignant polyps are easy to infiltrate the liver and should be treated with positive attitude. ⑤ Symptoms: Those with symptoms are considered for surgical treatment. 3.Surgical indication The radical school emphasizes that all PLGs have the possibility of malignancy and should be removed once found, although it may lead to an increased incidence of right hemicolectomized colon cancer. Some scholars believe that polyps with diameter >10mm, single and age >6O years should be highly suspected of gallbladder cancer and should be operated promptly. Other scholars suggest that a single lesion >6O years old, with coexisting gallstones, and >10 mm in diameter should be cholecystectomized even if asymptomatic. Others believe that all polyps >10 mm in diameter should be operated. Some scholars also point out that any PLG without a tip should be removed immediately even if the diameter is <10mm, while PLG with a tip can be operated when the diameter is >10mm. The indications for surgery are: ① polyp diameter >10mm, single or multiple; ② age >5O years; ③ combined with gallbladder stones; ④ there are doubts in the observation and follow-up or the patient is too worried and determined to operate; ⑤ polyp diameter >15mm should be regarded as absolute indication for surgery; ⑥ if the polyp diameter <10mm, regular ultrasound review should be performed in 3-6 months. If the diameter increases, clinical symptoms appear or symptoms worsen, surgery should be performed as soon as possible. (7) Combination of acute and chronic cholecystitis or history of biliary bleeding, pancreatitis, jaundice. In addition, we should pay attention to the follow-up observation: ① PLG diameter <5mm, multiple, tipped, no stones can be suspended surgery, regular ultrasound review; ② diameter 5-10mm, no stones and no malignant features, ultrasound follow-up; if found to have a tendency to increase, then should be actively surgical treatment; ③ for PLG patients, intracavitary exploration of the gallbladder is feasible, for good gallbladder function, benign polyps can be completely removed, stones can be For patients with PLG, intracavitary exploration of the gallbladder is feasible. 4.Surgical method Conventional cholecystectomy is performed for benign PLG, and the plasma membrane layer of the gallbladder bed is preserved. For PLG that cannot be completely characterized before surgery, rapid frozen pathological examination is required during surgery, and if the diagnosis is gallbladder cancer or cannot be excluded, the following principles are referred to: ① Early stage gallbladder cancer is confined to the plasma membrane. Full-thickness cholecystectomy can be performed without local lymph node dissection. ② For cancer diameter ~18mm, full-thickness cholecystectomy should be performed via laparoscopy. If the cancer has infiltrated into the subplasma membrane, then the laparotomy should be performed with partial resection of liver tissue in the gallbladder bed and local lymph node dissection. For those suspected to be cancerous, it is better to perform open surgery directly. If the diameter is >18mm, it may invade the plasma membrane layer, so laparoscopic surgery is not suitable, but direct open cholecystectomy should be performed, and if it is confirmed as gallbladder cancer according to the rapid cryopathological results during surgery, enlarged cholecystectomy with lymph node dissection should be performed. The prognosis of gallbladder cancer is extremely poor, with a 5-year survival rate of <5%. In order to prevent cancer, many people believe that early surgery should be performed for PLG, and there is a trend of expanding the indication in China. However, gallbladder resection can partially cause physiological dysfunction of bile duct and intestine, leading to higher incidence of bile duct stones and colon cancer. The incidence of bile reflux gastritis and post-cholecystectomy syndrome has been reported to be above 10%. In view of this, a treatment method of removing polyps while preserving a functional normal sac has been proposed for benign PLG, called polypectomy with preservation of the gallbladder. These include trans-laparoscopic cholecystectomy with sutured B ultrasound-assisted percutaneous choledochoscopic PLG removal, percutaneous choledochoscopic PLG microwave resection, and percutaneous PLG removal. However, before deciding on such procedures, it must be clear that the gallbladder is emptying and other functions are normal, which has not yet been widely accepted.