Due to the improvement of material living standard and the increase of urban living pressure, many urban people are often faced with unscientific eating habits (such as skipping breakfast, excessive cholesterol intake), unhealthy living habits (staying up late, smoking, alcohol abuse, etc.) and other problems, so the incidence of gallbladder polyps and gallbladder stones has greatly increased. Many people will find polyps or stones by chance when they have an ultrasound during their regular checkups, and some people only notice them when they have right-sided abdominal pain after drinking alcohol or eating a fatty diet. At this point, a series of questions arise: Are gallbladder polyps or stones serious? Will it become cancer? Do I need surgery or not? Can the gallbladder be preserved if surgery is performed? Will there be any effect if the gallbladder is removed? The above questions are often the focus of most patient consultations, so let’s discuss these issues with you now: 1, are gallbladder polyps and gallbladder stones serious? By definition, gallbladder polyp is actually an image description, referring to the growth of polyp-like lesions within the gallbladder. Most gallbladder polyps are benign, but polyps over 1.0 cm are at risk of cancer. In other words, whether single or multiple, if the ultrasound report indicates that the gallbladder polyp is less than 1.0 cm, its chance of malignant change is very, very low, so basically you can relax and not worry about it; while for lesions larger than 1.0 cm, you need to be alert and decide the next step of treatment as soon as possible to avoid delaying the disease. Gallbladder stones are the most common type of disease in the biliary system. On the whole, stones are not particularly fatal, but usually stones may cause cholecystitis, cholangitis, or even the rather dangerous pancreatitis, and long-term recurrent chronic inflammation is the breeding ground for tumors, so we need to pay enough attention to stones, review them regularly, and decide whether to give treatment according to the specific situation. 2.Will gallbladder polyps and stones become cancer? The concept of gallbladder polyps actually includes some early cancerous lesions. Among them, tumor polyp (mainly adenoma) is an important risk factor for gallbladder cancer. When the diameter of gallbladder polyp is larger than 1.0cm, the incidence of cancer increases significantly, and when it is larger than 2.0cm, it can be almost directly considered as malignant tumor. Among the non-neoplastic polyps, adenomyosis of gallbladder is considered as precancerous lesion, and its cancer rate is 3-10%. 50-70% of gallbladder cancers will be combined with gallbladder stones, but only 1.5%-6.3% of gallstone patients will develop gallbladder cancer, and some studies have shown that the incidence of gallbladder cancer is 7 times higher in patients with gallstones than in those without stones. In addition, the larger the stones are, the higher the risk of gallbladder cancer. The risk of gallbladder cancer is 10 times higher for stones larger than 3.0cm in diameter than for stones below 1.0cm. 3.When do I need surgery? At present, there are many domestic and foreign consensus and guidelines discussing when gallbladder polyps or gallbladder stones need to be treated surgically, and the more recognized view is that for gallbladder stones: (1) asymptomatic or mildly symptomatic patients, especially young patients, do not need routine surgical treatment, but can be observed regularly for 3-6 years; (2) for elderly patients, considering that further increase in age will increase the risk of surgery, preventive surgery can be considered. (3) For patients with gallbladder wall thickening, gallbladder stones larger than 62.5px and other high-risk factors for gallbladder cancer, surgical treatment is feasible regardless of the presence of symptoms; (4) Patients with gallbladder stones causing clinical symptoms, affecting work and life, or those with previous episodes of acute cholecystitis or acute pancreatitis are recommended to undergo surgical resection. (5) Patients with loss of gallbladder function and porcelain gallbladder should undergo surgery. For gallbladder polyps: (1) For polyps with multiple, less than 1.0 cm, and with a tip, if there are no obvious clinical symptoms, regular review in 6-12 months can be considered. (2) For single, less than 1.0cm polyps, regular review can be done in 3-6 months, and if the polyps tend to increase in size or cause clinical symptoms, surgery can be considered. (3) Polyps larger than 1.0 cm, or cause obvious symptoms affecting work life, may choose to undergo surgery. (4) Patients with gallbladder cancer characteristic factors such as wide base, age greater than 50 years old, combined gallbladder stones and rapidly increasing lesions should decide whether to perform juice harvesting according to the situation. 4.If surgery is needed, is it better to choose bile cutting or bile preservation? At present, if the above-mentioned surgical indications are met, the primary recommended surgical method is laparoscopic cholecystectomy, which removes the gallbladder and removes the soil for the growth of gallbladder polyps or stones, and is a method to cure the symptoms and the root cause of the disease. Although stones are removed and polyps are removed, the mechanism of stone formation and polyp formation is not changed, and the recurrence rate is a problem that must be faced after surgery. In addition, biliary stone removal surgery may cause damage to the gallbladder or bile duct, which in turn aggravates the inflammation of the biliary system, increases the patient’s pain, and may require a second surgery or even multiple surgeries. Therefore, before choosing biliary preservation surgery, it is necessary to strictly conform to its indications, i.e., the gallbladder must function well, otherwise biliary preservation will lose its only meaning. Therefore, at present, biliary surgery is only suitable for some young patients with good gallbladder function and no obvious clinical symptoms, and more evidence is needed to support the specific efficacy of the procedure. 5.What are the effects of gallbladder removal? Many people have some misconceptions about the function of the gallbladder, thinking that the gallbladder is the place where bile is produced, but in fact, the liver is the real place where bile is produced, while the gallbladder only plays a shopping bag-like storage function. Generally speaking, after gallbladder removal, there will be short-term digestive symptoms, mainly manifested as bloating, diarrhea and other indigestion symptoms after eating fatty foods (the time varies from a few months to 1 or 2 years, depending on the person), but with the body’s self-regulation and adaptation, the bile duct will compensate for thickening and partially replace the function of the gallbladder, and the lower sphincter of the common bile duct will rhythmically switch on and off to adapt to food digestion and thus slowly return to its previous state. Although some studies have shown that there is a risk of bile reflux gastritis or increased risk of colorectal cancer after gallbladder removal, the chances are low and there is absolutely no need to choke on it and worry too much about it. The above surgical indications have been determined with reference to these postoperative risks, weighing the pros and cons. The above are also just some of my rough thoughts on the diagnosis and treatment of gallbladder stones and polyps, which I hope can help the patients concerned. Medicine is always complex and difficult, and full of uncertainties, and a lot of knowledge and experience are constantly being updated, so when you encounter gallbladder polyps or stones, you are advised to go to a regular hospital for better treatment.