Gallbladder stones are a common digestive tract disease, which is common in western countries, and the incidence can be as high as 10 – 20%. The prevalence of gallbladder stones in China is about 4.8%, rising with age, with a prevalence of up to 11.2% in elderly people over 70 years of age. Risk factors for the occurrence of gallbladder stones include age, gender (female prevalence), race (Pima Indians can have up to 70% incidence), pregnancy, obesity, rapid weight loss, cirrhosis, hemolytic anemia, hyperlipidemia, diabetes, long-term intravenous nutrition, post ileal resection, post vagotomy, etc. Some drugs can also cause gallbladder stones such as estrogen, birth control pills, lipid-lowering drugs ( Clofibrate), ceftriaxone and octreotide, etc. Most gallbladder stones are asymptomatic for life and are called silent gallstones. About 20% of patients with asymptomatic gallstones may develop symptoms during follow-up. The typical symptom of gallbladder stones is biliary colic, which usually presents as spasmodic pain in the right upper abdomen that may radiate to the right shoulder and back. It can also be manifested only as upper abdominal fullness and nausea, which are often mistaken for “stomach problems” by patients. Symptomatic gallbladder stones are prone to complications such as acute cholecystitis, acute cholangitis and acute pancreatitis, mainly due to stones falling from the gallbladder into the cystic duct or common bile duct, causing obstruction of the cystic duct or common bile duct and affecting the normal excretion of bile and pancreatic juice. Long-term gallbladder stones and chronic cholecystitis, especially filled stones, can lead to loss of gallbladder function and atrophic cholecystitis, and some of them can become cancerous. Patients can be divided into 4 categories according to the presence or absence of symptoms: 1) asymptomatic gallbladder stones (stones on ultrasound and other imaging); 2) symptomatic gallbladder stones without complications (acute cholecystitis, acute cholangitis and acute pancreatitis); 3) gallbladder stones on imaging but with atypical symptoms (chest pain, eructation, acidity, nausea and abdominal distension); 4) typical biliary symptoms without stones on imaging. Patients in category 1 generally do not need surgery, regular checkups to observe changes in gallbladder stones and physical exercise can reduce the chance of asymptomatic gallbladder stones turning into symptomatic stones. However, for patients with filled stones, atrophic cholecystitis and gallbladder stones combined with adenomatous polyps, the gallbladder should be removed prophylactically to prevent cancer. In patients with recurrent symptoms, surgical management of gallbladder stones (usually laparoscopic cholecystectomy) is recommended to eliminate symptoms and prevent complications such as cholangio-pancreatitis, but medication such as ursodeoxycholic acid (UDCA) lithotripsy can also be considered for young patients with mild symptoms (the success rate of lithotripsy is low, reported to be 37%. The success rate of lithotripsy has been reported to be 37%, but in practice it is even lower). Patients with symptomatic gallbladder stones have a complication rate of about 2 – 3% per year, with a 30% chance of recurrence within 1 year once a complication has occurred, and the gallbladder should be removed during or after treatment of the complication. Patients in category 3 usually need to exclude other diseases such as coronary heart disease, ulcer disease, chronic gastritis and chronic colitis first, and cholecystectomy should be performed cautiously for gallbladder stones without curvilinear symptoms, with 56–86% symptom relief, and some patients can still have symptoms after surgery. For patients who are difficult to determine whether the symptoms are from gallbladder stones, ursodeoxycholic acid diagnostic treatment can be considered for 3 months, and if the symptoms can be relieved laparoscopic cholecystectomy is recommended to obtain long-term symptom relief. Patients in category 4 with typical biliary colic symptoms but no gallbladder stones or other diseases on imaging can be diagnosed as functional gallbladder dysfunction, and cholecystectomy can be considered to eliminate symptoms if the pain affects work and life. Laparoscopic cholecystectomy is the preferred method of cholecystectomy because of its shorter hospital stay (usually day surgery), less pain, faster recovery and smaller scars than open cholecystectomy. Of course, laparoscopic cholecystectomy also has a certain rate of conversion to open surgery, and the chance of biliary injury is slightly higher than that of open cholecystectomy (0.3 – 0.5% vs. 0.1 – 0.2%), and an experienced hepatobiliary surgeon should be chosen.