Gallstone disease is one of the most common diseases in hepatobiliary surgery, summarize the clinical patients are most concerned about several issues, and share with you. 1.Gallbladder stones, to open or not to open? In principle, surgery is recommended for patients with right upper abdominal pain and discomfort, especially for patients with recurrent attacks; for elderly patients with underlying diseases, even if they are asymptomatic, surgery is recommended as soon as possible because the risk of acute attack is great; for patients with suspected risk of malignancy such as gallbladder atrophy found on physical examination, surgery is recommended as soon as possible. 2.When is surgery more appropriate? It is generally recommended to operate when there is no pain, and for acute attacks, it is more appropriate to operate 1-2 months after the inflammation is controlled, because at that time the gallbladder is not inflamed and edematous, the operation is simple, recovery is fast and complications are few. If conservative treatment is not effective, emergency surgery is required, but the risk is much greater. 3. Minimally invasive, or open? I just want to say that one is a fine operation under a high-definition magnified view many times, and the other is a deep small incision to pull out by hand. There is no doubt that laparoscopic cholecystectomy has been the international gold standard for decades. Of course, there are difficulties in laparoscopic surgery or need open surgery as a supplement, and the incision must not be small then. 4.How is cholecystectomy done? Can it be opened cleanly with minimal invasion? Just to clarify, the process of gallbladder removal is exactly the same for minimally invasive and open surgery. The difference is that the minimally invasive abdominal wall puncture is small, and we will put the gallbladder in a retrieval bag to remove it. Sometimes, because of too many stones or gallbladder edema, we will cut up the specimen to facilitate removal, but the gallbladder is removed to make sure it is intact, not piece by piece, and there will be no residue. 5.Can I have my gallbladder preserved? How is a biliary lithotomy done? Ultrasound or MRI and other imaging tests clearly single or few stones, intraoperative choledochoscopy or cholecystoscopy must be clear that there are no residual stones or sediment, otherwise, stone recurrence is the biggest pain after biliary preservation surgery. 6.What is the difference between bile duct stones and gallbladder stones? The growth location is different, and some of the etiology is different. Some bile duct stones are gallbladder stones that fall into the bile duct through the gallbladder duct, called secondary bile duct stones, while primary bile duct stones have a higher recurrence rate. Common bile duct stones may cause bile duct obstruction and affect liver function, etc. In principle, surgery is recommended. 7.Why is it necessary to put drainage tube for bile duct stone surgery? Because the bile duct is the only way for the bile secreted by the liver to enter the intestine, so bile duct stones cannot be simply removed like gallbladder stones. When the bile duct is incised to remove the stone and then sutured, the healing process may cause biliary stricture because of the constriction of the incision, so we routinely leave a T-tube in the bile duct to prevent stricture and bile leakage. At present, the T-tube is usually left in place for 2-3 months, and it can be removed only after there is no stricture or stone remaining on the imaging. 8.What is ERCP? There is another treatment method for common bile duct stones. The opening of the bile duct into the intestine is found through gastroduodenoscopy, and a retrograde tube is inserted to remove the stones from the bile duct. This is a better minimally invasive treatment because there is no need to incise the common bile duct and no drainage is left in place. We recommend that patients with gallbladder stones combined with bile duct stones can be treated in two steps, with ERCP first to remove the bile duct stones and then laparoscopic cholecystectomy to achieve the least trauma and fastest recovery. However, the relative cost is higher and ERCP does not guarantee 100% success. 9.What will be the impact of gallbladder removal on my life? The physiological function of the gallbladder is to concentrate and store bile, so a low-fat diet is needed for a short period of time after gallbladder removal. Therefore, it is normal to find mild dilatation of bile ducts after cholecystectomy and there is no need to worry.