Gallbladder stones are a very common digestive system disease. When gallbladder stones present with symptoms of cholecystitis, gallbladder atrophy, combined with gallbladder polyps, or asymptomatic gallbladder stones with a history of more than 10 years and a stone diameter of more than 3 cm, surgery is often required. With the improvement of medical devices and the update of treatment concept, gallbladder surgery methods are diversified, but various methods often have their own surgical indications, so it is very important for patients to choose the appropriate surgical method. 1.Gallbladder puncture and drainage is mainly suitable for acute cholecystitis attacks, advanced age combined with serious cardiopulmonary disorders, unable to tolerate general anesthesia surgery; gallbladder inflammation is too heavy, serious adhesions with the surrounding tissues and intestines, the implementation of surgery can not be safely separated or the possibility of serious complications (my experience is that the inflammation of the gallbladder even continues to develop for more than 7 days, the difficulty of surgery increases significantly, do not easily challenge!) . Approach: Under ultrasound or X-ray surveillance, the gallbladder is accessed through a transdermal liver puncture and then a drainage tube is placed with the aim of draining the pus-forming bile from the gallbladder, allowing the gallbladder inflammation to gradually subside, and surgery can usually be performed after 2 months when the gallbladder inflammation is reduced. If the operation is still not tolerated after 2 months, the drainage tube can be dilated and choledochoscopic stone extraction surgery, also called PTCS surgery, can be performed. 2. Cholecystostomy is also suitable for acute cholecystitis attacks, and surgery has been performed, but intraoperative adhesions between the gallbladder and intestinal ducts and surrounding important organs are found to be so severe that they cannot be safely separated and cholecystectomy cannot be completed. However, two months after the operation, surgery is still needed. At present, this operation is basically replaced by gallbladder puncture and drainage, so try to avoid the implementation of this operation. With the improvement of people’s living standards and the pursuit of a better life, the role of the gallbladder has been paid more attention to, and biliary surgery has been gradually carried out in recent years in China, and has become an important surgical procedure for the treatment of gallbladder stones. Biliary surgery is currently controversial, and I will discuss this aspect in subsequent articles. The Chinese Physicians Association Endoscopic Minimally Invasive Biliary Surgery Committee has updated the treatment guidelines several times, trying to rationalize this surgical option. At present, the procedure is mainly suitable for early onset of gallbladder stones, good gallbladder function and controllable gallbladder stone recurrence factors, etc. The disadvantage of the procedure is that it cannot yet completely inhibit stone recurrence after biliary preservation. The choledochoscope is withdrawn to ensure that the cervical duct of the gallbladder is clear and free of stones, and the incision of the gallbladder is finely closed with absorbable sutures. The use of choledochoscope and the improvement of suture material make the biliary surgery clearly different from the biliary surgery in the era of cholecystectomy, and there is no problem in taking out the stones, but the choledochoscopic observation should be paid attention to when performing this surgery. Therefore, the procedure undoubtedly places higher demands on the surgeon. Figure 3, laparoscopic endoscopic minimally invasive biliary stone retrieval surgery 3.2 Biliary surgery via natural cavity Biliary surgery via natural cavity is mainly operated by endoscopists, which is also a technical innovation in our national medical community, but it is also more controversial at present. The incision is made and the stone is removed from the gallbladder. After the stone is removed, the gallbladder and the stomach or colon are sutured endoscopically. This operation is complex and difficult for endoscopists and is currently performed in a few large gastrointestinal endoscopy centers in China. The biggest advantage of this operation is that there is no incision on the body surface and no pain on the second day of the operation, which makes it more suitable for people with strong cosmetic needs. The controversial point is that it is more important to have a superficial incision and a gastric or colonic incision. 4, cholecystectomy is the most classic method of treating gallbladder stones and is one of the most performed surgeries. At present, it is basically laparoscopic surgery, and the latest Tokyo guidelines for cholecystitis believe that open surgery has no advantage over laparoscopic surgery. The procedure: the gallbladder artery and the cervical duct are isolated, the gallbladder artery and the cystic duct are severed by ligation, and the gallbladder is stripped from the gallbladder bed. The surgical steps are relatively simple, and laparoscopic surgery can be performed with four holes, three holes, two holes, and a single hole depending on the difficulty of the surgery and the cosmetic needs of the patient. The difficulty of cholecystectomy varies widely, and it is easily a stumbling block and nightmare for surgeons because of the high anatomical variation in the porta hepatis and the heavy inflammation of the gallbladder. Among them, bile duct injury in laparoscopic surgery causes the most damage to patients, which can seriously lead to recurrent bile duct stricture, intrahepatic bile duct stones or cirrhosis, and individual patients who therefore perform liver transplantation have also been reported, and also has a great psychological impact on surgeons, and has been made a permanent pain for surgeons by Huang. Therefore, do not simply think that it is a minor surgery, but pay great attention to it. Conclusion: Diseases and surgical techniques are constantly evolving and changing, there is no one technical tool that can be used all over the world, gallbladder stones are the main chronic disease in China, the medical community is always probing to apply the most reasonable technology surgery to the treatment of patients.