Cholelithiasis is one of the most common diseases in hepatobiliary surgery, summarize the clinical patients are most concerned about several issues, and share with you. 1, gallbladder stones, open or not open? Young patients, stones are not big, asymptomatic, can not operate, pay attention to diet, regular follow-up review; right upper abdominal pain and discomfort symptoms, especially recurrent attacks of patients, in principle, are recommended surgery; elderly patients, underlying diseases, even if asymptomatic, conditions allow it is also recommended to operate as soon as possible, because once the risk of acute attack is very high; physical examination found that there is a risk of malignant transformation of the gallbladder atrophy and other suspected, as soon as possible surgery. 2.When is it more appropriate to operate? It is generally recommended to operate when there is no pain, and it is more appropriate to operate 1-2 months after the inflammation of acute attack is controlled, because there is no inflammation and edema of the gallbladder at this time, and the operation is simple, with fast recovery and few complications. Conservative treatment is ineffective must be emergency surgery, but the risk is much higher. One is a high-definition magnification of many times the field of vision under the fine operation, one is a deep small incision to pull out by hand, there is no doubt that laparoscopic cholecystectomy has been the international gold standard for decades. Of course, in laparoscopic surgery is difficult or need to open surgery as a supplement, then the incision will certainly not be small. 3.How does cholecystectomy work? Minimally invasive can open clean? Look at the picture together. Just to be clear, the process of cholecystectomy, minimally invasive and open surgery is exactly the same. The difference is that the minimally invasive abdominal wall puncture port is small, we will put the gallbladder in the retrieval bag to remove, sometimes because of excessive stones too large, or gallbladder edema, we will cut the specimen to facilitate the removal of the gallbladder, but the gallbladder removed to determine the complete, not a piece of a piece of the excision, and there will be no residual. 4.Can you preserve the gallbladder? How to do biliary lithotripsy? Ultrasound or MRI and other imaging tests to determine the single or few stones, the operation must be choledochoscopy or cholecystoscopy to determine that there is no residual stone or sediment, otherwise, the recurrence of stones is the biggest pain after biliary conservation surgery. 5.What is the difference between bile duct stones and gallbladder stones? The growth location is different and some of the etiology is different. Some bile duct stones are gallbladder stones that fall into the bile duct through the cystic duct, called secondary bile duct stones, while primary bile duct stones have a higher recurrence rate. Choledocholithiasis may cause bile duct obstruction, affecting liver function, etc. Surgery is recommended in principle. 6.Why is it necessary to put a drain in bile duct stone surgery? Because the bile duct is the only way for bile secreted by the liver to enter the intestines, 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 time may cause bile duct stenosis due to contraction of the incision, so we routinely leave a T-tube in the bile duct to prevent stenosis and bile leakage. At present, the T-tube is usually left in place for 2-3 months, and it can only be removed after there is no stenosis or stone residue on imaging. 7.What is ERCP? There is another treatment for choledochal stones. The opening of the bile duct into the intestines is found via gastroduodenoscopy, and a retrograde cannula is inserted to remove the stones from the bile duct. This is a better minimally invasive treatment because it does not require incision of the common bile duct or indwelling drainage. We suggest that patients with gallbladder stones combined with bile duct stones can undergo a two-step procedure, first ERCP to remove the bile duct stones and then laparoscopic cholecystectomy to achieve the least trauma and fastest recovery. However, the cost is relatively high, and ERCP does not guarantee 100% success. 8. How will gallbladder removal affect my life? The physiological function of the gallbladder is to concentrate and store bile, so a low-fat diet is needed in the short term after gallbladder removal. Generally, the bile ducts will be compensated for the expansion of part of the gallbladder in 2-3 months, and then the diet can be basically normal, which has no effect on life. Therefore, it is normal to find mild dilatation of the bile ducts after cholecystectomy, and there is no need to worry.