Patients with acute gallstones do not necessarily need surgery immediately. Acute gallstones usually include two conditions, as follows: first, acute calculous cholecystitis, if the ultrasound examination suggests that the gallbladder wall thickening is less than 3mm, surgery can be considered. If the ultrasound indicates that the thickness of the gallbladder wall is more than 3mm and the onset time is more than three days, emergency surgery is not recommended. Because the local edema is more serious at this time, emergency surgery may accidentally injure the bile duct and even cause serious sequelae. Second, for bile duct stones, if acute cholangitis occurs, emergency surgery is usually required. If surgery is not performed and the obstruction is not released, bile stagnation secondary to bacterial infection can cause obstructive purulent cholangitis and even infectious shock, which can endanger the patient’s life. Whether to operate for acute gallstones depends mainly on the different parts of the stone. If it is a simple gallbladder stone, emergency surgery may not be required, while if it is a bile duct stone, emergency surgical treatment is required.