The incidence of gallbladder stones is 10-20% and increases with age, and is one times higher in women than in men. 50-70% are asymptomatic stones. The term asymptomatic stones refers to the absence of biliary colic or other clinical manifestations associated with stones, such as acute endocholangitis, cholangitis, cholangitis of biliary origin or with epigastric pain radiating to the living scapula of the back, at the time of ultrasonographic detection of gallbladder stones. Prior to the advent of laparoscopic cholecystectomy, cesarean cholecystectomy was not considered a procedure that could be easily determined for physicians and patients. It is well documented that less than one-third of asymptomatic gallstones develop symptoms and complications during subsequent observation, so most scholars advocate not performing cholecystectomy for asymptomatic stones, but rather follow up. However, there have been follow-ups of up to 15 years that found that 10%, 15%, and 18% of people developed symptoms at 5, 10, and 15 years, respectively, with some of them developing complications. It is clear that with stones there is a possibility of symptoms or complications, and it is also clear that a very high percentage of people can live with stones in peace. But note that the key question is, can we predict when and what kind of complications will occur in a given individual? Therefore, the probability of symptoms or complications is not a decisive factor in deciding whether or not to operate for a particular individual, but rather a factor in weighing whether or not the risk is worth it. Without an adequate basis for the long-term effects of cholecystectomy on a person, passive observation is certainly taking a risk, as complications can progress directly from asymptomatic to complications. The authors have been engaged in research on the prevention and treatment of gallbladder stones since 1989, and it has been nearly 20 years since then. Continuous study, extensive clinical practice and observation have led to an evolution in understanding of the clinical manifestations, natural regression, complications and sequelae of gallbladder stones, the advantages and disadvantages of surgical resection versus biliary stone retrieval and the long-term effects, and the psychology of the patient. Based on a belief and a naturalistic viewpoint, I started my clinical research on non-surgical treatment of gallbladder stones by “lithotripsy-litholysis” and percutaneous choledochoscopic gallbladder stone extraction, and I can be said to be a devout gallbladder preservationist. Later, he observed a large number of recurrences after “lithotripsy-lithotripsy” treatment, so his original belief in biliary preservation was shaken. He became a veritable “king of gallbladder cutting” and has performed more than 19,000 laparoscopic cholecystectomies in the past year. In fact, during the interaction with various gallbladder stone patients, including the follow-up of the early gallbladder stone patients, the diversity and complexity of clinical manifestations have always forced me to think about the rationality of simple cholecystectomy. Therefore, since 2004, I have been experimenting with percutaneous and laparoscopic gallbladder stone extraction in a few patients with functional gallbladder stones. Now I should say that I am a rational gallbladder preservationist. After clinical practice and observation, I came to the following conclusions: 1. Patients with gallbladder stones have a natural desire to preserve their gallbladder regardless of whether they have symptoms or not, and the asymptomatic ones are even stronger. Nearly half of the asymptomatic patients want to remove the stones but preserve the gallbladder out of fear of possible complications of the stones; symptomatic patients are relatively easy to accept laparoscopic cholecystectomy, but the majority still require gallbladder preservation. 2. The recurrence of stones after biliary preservation therapy is relatively high, but not necessarily recurrent, and even if recurrence can still be asymptomatic. The postoperative feeling of biliary treatment has a great relationship with the presence or absence of symptoms before surgery, and those who have no symptoms before surgery still have no symptoms after surgery, while those who have symptoms before surgery often have symptoms after surgery. For those with heavy preoperative symptoms, especially those with biliary colic, the effect of stone extraction seems obvious, and the biliary colic definitely disappears. Most of the symptoms of epigastric pain will not disappear after stone extraction, probably because the preoperative symptoms originate from chronic inflammation of the gallbladder. 3. Once clinical symptoms appear, the possibility of complications increases significantly. More than 1/3 of the patients hospitalized in the past were patients with obvious symptoms or complications, and their postoperative sequelae (such as diarrhea, epigastric occult pain and dyspepsia) are significantly more than those of patients without complications; early laparoscopic surgery for acute cholecystitis has obvious advantages over postponed surgery Combined with foreign literature about the natural evolution of gallbladder stones The evolution of gallbladder stones can be divided into the following phases: genetic phase physiological-biochemical phase physical phase symptomatic phase complication phase Due to the lack of in-depth research on the causes of gallstones, it is not yet possible to intervene in the first two periods, which are the problem of stone prevention and prevention of recurrence. In the physical phase, the asymptomatic phase of gallbladder stones, is it better to wait passively or to intervene actively? The symptomatic phase, although not necessarily fatal, certainly affects the quality of one’s survival and carries the risk of entering the complication phase, not to mention that we cannot yet predict if and when a specific person with gallbladder stones will enter the complication phase, so intervention in this phase becomes of critical importance. Once in the symptomatic phase, treatment is aimed at preventing complications, and intervention at this time is advocated by most authentic schools of thought, and cholecystectomy is considered the only “legal” one. Laparoscopic cholecystectomy has become the weapon of choice because of its advantages of less damage, faster recovery and postoperative aesthetics. At the same time, because of the advent of laparoscopy, the existence of the gallbladder is becoming more and more insignificant! This is clearly an inhumane choice, a manifestation of temporary human incompetence The current debate on gallbladder stones is focused on two points: first, whether asymptomatic stones need to be treated; second, whether to preserve or cut the gallbladder. In today’s era of minimally invasive surgery, my opinion is that gallbladder stones not only need to be treated, but also treated early. For asymptomatic gallbladder stones, one should not wait passively, but should take aggressive non-surgical methods to eliminate stones and prevent them from developing into the symptomatic stage, and firmly oppose gallbladder removal. For symptomatic gallbladder stones should be treated differently. If the gallbladder is functional, the possibility of stone recurrence is low, and biliary origin epigastric symptoms are excluded, biliary stone extraction can also be chosen; if the gallbladder is not functional, the inflammation is relatively heavy, and the clinical symptoms are estimated to improve inexactly after stone elimination, laparoscopic cholecystectomy is performed. If the stones recur, laparoscopic removal of the gallbladder is advocated. Laparoscopic cholecystectomy should be performed early once it enters the complication phase, such as acute cholecystitis (including gallbladder necrosis). Although gallbladder stones are non-neoplastic diseases, they can also be fatal, so the principle of “early detection, early diagnosis and early treatment” also applies. At the same time, the gallbladder, as an innate natural organ, has an indisputable value, and it is our duty to diagnose, care for and protect it, which is the direction of medical research.