Patients with asymptomatic gallbladder stones are often encountered in clinical practice and are hesitant to operate. In fact, medical opinion has long been divided on the management of these patients, but in recent years, there has been a convergence of opinion both at home and abroad that some patients with asymptomatic gallbladder stones should be treated surgically. Survey data show that about half of the patients with gallbladder stones can remain asymptomatic for the rest of their lives, and therefore many doctors do not advocate surgery. In what cases do gallstones require surgical treatment? There are many treatment options for gallstones. The decision of what treatment method to use, when surgery is necessary, and when to choose surgery is not up to the patient or the doctor, but should be considered based on the objective and specific condition. The most effective method for gallbladder stones is cholecystectomy. Nowadays, the most widely carried out surgical method at home and abroad is laparoscopic cholecystectomy, which has the advantages of less trauma, less pain, faster recovery, safety and fewer complications, and has basically replaced the traditional open cholecystectomy. What are the dangers of asymptomatic gallstones left untreated for a long time? Many patients have been suffering from gallstones for more than 10 years, but because the symptoms are not serious, they have not been treated. However, studies have shown that there is a close relationship between gallbladder cancer and the occurrence of gallbladder stones, and it is even believed that gallbladder stones are precancerous lesions of gallbladder cancer. Studies have shown that the risk of gallbladder cancer is 6-15 times higher in patients with gallbladder stones than in those without stones, and the risk of gallbladder cancer is 10 times higher in those with a diameter of 3 cm or more than in those with a diameter of 1 cm or less. In addition, the duration of stones is also related to the occurrence of gallbladder cancer. Long-term existence of gallbladder stones will cause gallbladder atrophy and calcification, and gallbladder cancer occurs in 20%-60% of patients with calcified gallbladder or porcelain-like gallbladder. Therefore, although asymptomatic gallbladder stones do not cause any obvious discomfort, they are not harmless to the human body and regular review is recommended. For patients with multiple small gallbladder stones, the stones can easily get stuck in the gallbladder duct or fall directly into the common bile duct, causing acute cholecystitis or obstructive jaundice (cholecystitis develops when stones get stuck in the outlet of the gallbladder, resulting in poor bile flow and secondary inflammation, and small stones can easily get stuck in the outlet of the gallbladder; obstructive jaundice is when stones fall into the common bile duct, just like the drain of a sink, causing a blockage of the common bile duct. (the blockage, the bile flows back into the blood, causing serious problems such as sepsis, jaundice, and shock). The ultrasound shows that the size of the stone is around 0.7-0.8 cm, and such a stone has the greatest potential risk of developing “biliary colic” after a long or short period of time in the future. This is because the diameter of the gallbladder duct (gallbladder outlet) is usually 3mm, and it usually has a certain stretch, so when a stone the size of a green bean or a soybean exists in the gallbladder, it is most likely to be stuck in the gallbladder duct due to improper diet, thus inducing that unbearable biliary colic. Stones that are too large or too small do not easily get stuck in the gallbladder duct and therefore do not easily cause biliary colic. Therefore, for patients with multiple small gallbladder stones, stones that tend to get stuck in the gallbladder duct, within especially patients with combined hypertension and diabetes (hypertension can be aggravated when the gallbladder is inflamed, and patients with diabetes have poor resistance to infection, and once inflammation and infection are not easily controlled), surgical treatment is recommended. In addition, some of our patients tend to visit us during acute attacks of cholecystitis, eager for immediate surgery to relieve the pain, but in fact, emergency surgery is not a good time for surgery, and most patients can be cured with regular anti-inflammatory conservative treatment. Emergency laparoscopic surgery is less safe and has more chances of complications, and most units do not advocate it, so because acute cholecystitis receives surgical treatment, most units will choose open cholecystectomy. Therefore, it is generally recommended to receive laparoscopic surgery when the patient is asymptomatic without an attack of cholecystitis or after the patient’s attack of cholecystitis is under control. There is no definite conclusion about the most appropriate time for surgery 1. If there is a history of biliary colic or a patient with potential biliary colic, I believe that surgery should be performed as soon as possible. Generally speaking, the patient should receive surgery 3 months after the gallbladder attack is controlled, but this cannot be generalized. For one thing, the impact of biliary colic on the patient is too great, and for another, some of such patients will subsequently induce pancreatitis, and then, what was a simple problem will become very complicated. 2, if the resting type of gallbladder stones, the patient is relatively young, the fat meal test confirmed that the gallbladder function contraction function is good, B-type examination found that the thickness of the gallbladder wall is normal, and the patient does not want to operate now, then temporarily do not operate. It is enough to pay attention to diet and not to induce biliary colic and cholecystitis. However, if the patient is over 60 years old and female, it is better to operate even if all other conditions are met. This is because stones irritate the gallbladder for a long time and may induce gallbladder cancer. Among gallbladder cancer patients, there are more women than men, and more senior than young people. Many elderly women had their gallbladder surgically removed due to gallbladder stones and septic cholecystitis, but the pathological examination results were gallbladder cancer. This is too small to lose. 3. If ultrasound examination confirms that the gallbladder wall has thickened and the contraction function is poor, or stones have filled the gallbladder, then it is actually a pathological gallbladder. Even if it is not removed, it does not play any role in the body, but is a possible cause of other diseases. 4. For patients who do not want to have surgery for the time being, do not listen to small advertisements of so-called stone removal treatment in newspapers and radio stations. If those methods are feasible, any regular hospital can introduce their drugs or therapies. 5. Look at the problem of gallbladder stones inducing pancreatitis or gallbladder cancer correctly. Don’t go to two extremes – either scoff at it or be scared to death. Not every patient will inevitably develop such a condition, but it is never a matter of bluffing on faith either. Choosing the right time to remove the gallbladder may be an unavoidable necessity in the lifetime of a patient with gallbladder stones.