Whether 2cm gallstones need surgery is mainly determined by whether the patient has clinical symptoms, some can be treated conservatively and some need surgery, as follows: 1. Conservative treatment: If the patient is found to have 2cm gallstones during physical examination, without any abdominal symptoms, the patient can be advised to adopt conservative treatment, and it is generally recommended to have a light diet, not to be able to eat greasy food. 2.Surgical treatment: If the patient has gallstones, there are some abdominal pain symptoms, such as vague pain and distension in the upper abdomen, as well as anorexia, nausea, etc., and a history of inflammatory episodes of the gallbladder, surgery is needed for treatment. Because after a long time, the stones may gradually increase in size and may lead to further aggravation of the inflammation of the gallbladder.