In 1992, the first laparoscopic common bile duct extraction was successfully performed in the United States. Since then, this technique has spread rapidly around the world and has been widely performed in China for a long time, and is favored by patients for its low trauma, mild postoperative pain, quick recovery, and short hospital stay. However, unlike the medical consensus that “laparoscopic cholecystectomy is the gold standard for the treatment of gallbladder stones”, laparoscopic choledochotomy has not yet become the “gold standard” for the treatment of common bile duct stones, which has led many patients to choose This makes many patients hesitant in choosing the surgical treatment for common bile duct stones, and some even delay the best treatment time. Therefore, it is very important to choose the correct surgical treatment for common bile duct stones in a timely manner. In order to properly choose the surgical procedure for common bile duct stones, let’s first look at the various conditions of common bile duct stones. According to the specific source of the common bile duct stones, they can be divided into: i. Primary common bile duct stones: the stones originate directly from the common bile duct. This can be roughly divided into two categories: 1. Combined gallbladder or intrahepatic bile duct stones 2. Stones in the common bile duct only, with no stones found in other bile ducts outside the common bile duct including the gallbladder 2. Secondary common bile duct stones: Stones in the common bile duct come from the gallbladder or intrahepatic bile duct. The common bile duct, which only presents as common bile duct stones, does exist, but only in a minority of cases. In this case, it is difficult to distinguish secondary from primary bile duct stones unless they are observed dynamically, and in fact, in terms of clinical treatment, the distinction is not very meaningful. Secondly, let us look at several major surgical methods for the treatment of common bile duct stones. Open choledochotomy: It is still widely performed in primary hospitals without laparoscopic surgery, and in hospitals where laparoscopic surgery is available, but the technique of laparoscopic choledochotomy for stone extraction has not been fully mastered. The long-term outcome is basically the same as that of laparoscopic choledochotomy, but the recent results are much different, with large trauma, long hospital stay, and relatively high incidence of short-term complications such as incisional infections. This procedure still has some advantages in the case of very large common bile duct stones or a combination of more intrahepatic bile duct stones. Laparoscopic choledochotomy: The technique is quite mature and can be performed by doctors who are skilled in laparoscopic techniques and choledochoscopic techniques. The operation is less traumatic, less complications, less postoperative pain, faster recovery, shorter hospital stay, and better short-term and long-term results. If the inflammation of the bile duct is not heavy and the biliary obstruction is completely removed, the common bile duct can be sutured in one stage directly without putting a bile duct drain. This method of surgery requires general anesthesia under current medical conditions. Endoscopic treatment of common bile duct stones: The end of the common bile duct opens into the duodenum, and there is a sphincter like a “one-way switch” controlling the end opening of the common bile duct, so that under normal circumstances bile can enter the intestine, but the intestinal contents cannot enter the bile duct, which is very important to avoid biliary tract infection. Under normal physiological conditions, stones smaller than 5 mm may pass through this “one-way switch” and be discharged into the intestine, while stones larger than 5 mm are generally difficult to pass without perceived intervention. This “one-way switch” has also become a “bottleneck” limiting endoscopic common bile duct stone extraction. To overcome this “bottleneck”, the following two methods have been adopted: 1) to destroy the “one-way switch”, eliminate the “bottleneck”, and then remove the stone, which will inevitably This will certainly lead to the reflux of intestinal contents, leaving sequelae. 2. The stones are crushed by various physical energies to reduce the size of the stones and then removed. There are various methods of stone crushing, but most of them bring certain side injuries because the accuracy of the energy strike is not yet fully controlled. There are many possible complications associated with endoscopic treatment of common bile duct stones, and serious complications include: postoperative biliary or incised sphincter bleeding; duodenal perforation; and acute pancreatitis, which can be very difficult to treat once they occur. In addition, endoscopic lithotripsy cannot solve the problem of gallbladder stones, and if combined with gallbladder stones, another laparoscopic surgery is required to remove the gallbladder. The advantage of this treatment is that for most patients no anesthesia is required. After familiarizing with the various conditions of common bile duct stones and the various methods of their treatment, making a choice of treatment for common bile duct stones is no longer a difficult task, and the following strategies are available for reference. 1. Patients with common bile duct stones combined with gallbladder stones should be preferred to laparoscopic choledochotomy for stone extraction as long as their general condition allows and they can tolerate general anesthesia; the common bile duct stones are removed at the same time as the gallbladder is removed, solving both problems at once; 2. Patients with intrahepatic bile duct stones, such as intrahepatic bile duct stones limited to one lobe or half of the liver, it is estimated that laparoscopic hepatectomy is feasible to remove them completely, which should also be preferred Laparoscopic choledochotomy for stone extraction; 3. Patients with simple common bile duct stones without combined gallbladder stones or intrahepatic bile duct stones are still recommended to undergo laparoscopic choledochotomy for stone extraction if they are not too old; for elderly patients, endoscopic treatment is recommended; 4. Patients with combined intrahepatic bile duct stones and more, estimated to be difficult to remove by choledochoscopy and difficult to remove by endoscopy, open surgery is recommended; 5. Elderly patients with cardiopulmonary insufficiency Patients with greater risk of general anesthesia are recommended to undergo endoscopic stone retrieval.