One of the most common questions that hepatobiliary surgeons encounter in their outpatient clinics today is whether they can perform “biliary stone preservation” surgery. The desire for biliary surgery is very good, and it is the most acceptable concept to patients, because it seems to be the closest to the human-centered purpose of medicine to successfully preserve gallbladder and remove stones. But not any gallstones or gallbladder polyps can do biliary surgery, now because of the developed network information, patients will check the information on the Internet before they go to the doctor, plus some hospitals and doctors vigorously promote and propaganda (many so-called gallbladder specialist hospitals or gallstone specialist hospitals, etc., I feel that some of them are misleading, hope that the majority of patients should be carefully considered!) The patient already has a preconceived view before seeing the doctor, making the doctor laugh and cry when he sees the patient, and you say that you can not bile preservation patients may also be mistaken that the doctor itself can not do this surgery. Here, I talk about my personal views on the treatment of gallbladder stones for the patients’ reference! There are 10 articles below, if patience is not enough, you can refer to The inequality of the size of the benefit of having a gallbladder or not: normal gallbladder > no gallbladder > poorly functioning diseased gallbladder, that is, no gallbladder (gallbladder removal) is better than keeping a diseased poorly functioning gallbladder! 1. Is gallbladder surgery new: Gallbladder surgery is actually not a new surgery, for the treatment of gallbladder stones, the earliest surgery created in 1867 is to cut open the gallbladder to remove stones, the patient’s symptoms are relieved, but it does not mean that the gallstones are cured, nine times out of ten patients gallbladder stones recur, then the doctor can not do anything until 1882, the German surgeon It was not until 1882 that Langenbuch, a German surgeon, was the first to complete a cholecystectomy, and to this day cholecystectomy is still the primary treatment for gallbladder stones and other gallbladder diseases. The success of laparoscopic cholecystectomy in 1987 changed the history of cholecystectomy and it is now widely performed. During this period of more than 100 years, there are also many old-timers who have explored the practice of bile preservation and stone extraction, but still the problem of stone recurrence cannot be solved in the face of it. 2, the causes of gallbladder stone formation: gallbladder stone formation is very complex, individual patients can not be generalized, here I will not say more, because it is impossible to say, anyway, not to take the stone can be good thing. It is very simple to think about to understand that everyone is born without gallstones, good gallbladder only after the growth of stones. After the stones have grown, the mucous membrane of the gallbladder will have more or less inflammatory changes, or the residue of stones deposited, even if the stones are taken away cleanly, the proportion of recurring stones is still very, very high. Even if the stones are removed, the recurrence rate is still very high. Stones can grow in gallbladders without stones, and it is impossible to control the recurrence of stones after removing the stones. There is no denying that a hepatobiliary surgeon can get the stones clean with the current technology, but by no means is the stone growth mechanism clean, so recurrence is understandable! (A little tongue twister, I don’t know if you can understand!) The most common harm of gallbladder stones is that they often cause discomfort or pain in the right upper abdomen, cholecystitis, and in severe cases, they may lead to septicemia, necrosis, perforation, diffuse peritonitis, and a certain percentage of long-term gallbladder stones may lead to gallbladder cancer, which has a very high malignancy and poor outcome. It is still common to see patients with untreated gallbladder stones that eventually become gallbladder cancer. Small gallbladder stones may also enter the common bile duct from the cystic duct and cause secondary choledocholithiasis, and may cause acute pancreatitis, which can be very painful and even life-threatening if serious. 4, gallbladder stones how to choose the surgical method of my opinion: cholecystectomy: gallbladder stones have inflammatory attacks or sediment-like stones, it is recommended to perform cholecystectomy, because the recurrence rate of gallbladder stone retrieval is too high, can reach 80% or more, and finally still need to perform cholecystectomy, but the problem can be solved in one surgery into two surgeries. Gallbladder removal surgery: For isolated or small number of asymptomatic stones with good gallbladder function and normal gallbladder appearance on ultrasonography and surgery, gallbladder removal surgery can be performed, but it is still necessary to insist on review after surgery. There is still a lack of reliable evidence-based medical evidence to prove that gallbladder stones can be bile-conserving surgery, and it is just another research phase. Patients themselves do not understand this and wishfully think that they are cured of gallstones by preserving their gallbladder and removing the stones. The recommendation is only that in the above case, the doctor can consider it if the patient personally wishes to insist on gallbladder preservation, but must explain to the patient that the possibility of recurrence is high and that gallbladder removal may be required later. From the doctor’s point of view, I think it is better to suggest cholecystectomy. 5, for gallbladder polyps: gallbladder polyps are different from stones, generally gallbladder polyps are not accompanied by inflammation of the gallbladder, and the function of the gallbladder is normal. Gallbladder polyps cannot be removed simply by removing the polyps, but should be removed together with the root of the polyps, and it is impossible to remove multiple polyps everywhere in the gallbladder. And the gallbladder neck duct is tiny, it is difficult to repair after removal, also need gallbladder removal. If the polyp is large or can be cancerous, it should be biopsied, and if there is a possibility of malignant transformation, gallbladder resection or radical surgery for gallbladder cancer should be added in time. 6.Can gallbladder stones be treated medically: Many patients ask this question, but unfortunately, once gallbladder stones are formed, at least there are no drugs that can reduce or eliminate the stones, if a doctor says they can, it can only be because the doctor is not too clear about the formation and structure of gallbladder stones or a “doctor” who simply sells drugs (note: the doctor here is in quotes). Of course, if there is such a possibility in a few years, at least a few decades or a hundred years later, this is the common wish of our doctors and patients. 7. Whether gallbladder stones can be lithotripsy: Some patients also ask whether lithotripsy is feasible, for gallbladder stones are different from ureteral or kidney stones. If gallbladder stones are crushed and drained, they are drained into the common bile duct, which is more dangerous than gallbladder stones and more complicated to operate. If the stones block the common bile duct, it may cause jaundice, the formation of cholangitis, pancreatitis, which is very dangerous and even life-threatening disease, so it is recommended that patients with gallstones should not listen to some “doctors” falsely to be able to use drugs to drain the stones or what new methods to break the gallstones (I think the real doctors usually do not say so, so do (I think the real doctors usually do not say so, do so are basically fake doctors to cheat money, of course, there are really “doctors” is too believe in their own medicine). 8, open surgery or laparoscopic surgery: undoubtedly more than 90% are laparoscopic cholecystectomy, but laparoscopic surgery in addition to the patient’s condition and anatomical structure, but also with the doctor’s skills or related, since the development of laparoscopic cholecystectomy, the proportion of biliary tract injury is about 1 to 5 per thousand! 9.What is the harm after gallbladder removal: The gallbladder as a human organ must have its value and function, which is to store and concentrate the bile, so that the bile excreted by the liver can be stored for backup when not eating, and then discharged at once when eating to facilitate the digestion of food. This explains why it is necessary to do gallbladder ultrasound in the morning on an empty stomach so that the gallbladder can be filled up for good observation, and it is not good to see clearly when the bile is drained out of the gallbladder after eating. So after the gallbladder is removed, the gallbladder’s function of storing bile is lost. The biggest impact may be that you cannot eat or drink a lot after the gallbladder is removed, so as not to excrete enough bile and cause indigestion. If this is the reason why you want to keep your gallbladder, then please think about whether you can eat and drink when you have a gallbladder now! 10. Reasons for gallbladder preservation: (1) Good gallbladder structure and function (2) Lesions can be completely removed: polyps removed or stones completely removed (3) If it is stones you are willing to bear the possible risk of another surgery. If these three items are complete, you can try, but of course your doctor is willing to do this surgery! The above is only for the reference of the patients, if the peer experts have different views or better suggestions, I hope to discuss or criticize the correction, all for the benefit of the patients!