With the improvement of living standard, the accelerated pace of life and the change of living habits in China, the incidence of gallbladder stones and gallbladder polyps is increasing year by year. In the past, patients with gallbladder stones and gallbladder polyps usually underwent cholecystectomy with many postoperative complications. Minimally invasive biliary surgery for gallbladder stones and polyps is less invasive and has fewer complications, but the recurrence rate of gallbladder stones or polyps is higher after surgery. How to reduce the recurrence of stones or polyps after minimally invasive cholecystectomy or gallbladder polyp removal has always been a concern for medical practitioners. Modern medical research has shown that the gallbladder not only has the functions of storage concentration, bile excretion and secretion, but also has the important functions of maintaining the hepatobiliary circulation of bile acids and immunity. For patients with gallbladder stones and gallbladder polyps, the aim of treatment is to relieve patients’ pain while preserving their gallbladder function. In recent years, many scholars have tried to carry out biliary surgery for gallbladder stones and gallbladder polyps based on the combination of modern lumpectomy technology, and achieved very good surgical results. However, some patients still have recurrence after surgery. How to reduce the postoperative recurrence rate is a clinical concern. The risk factors for recurrence of gallbladder stones or polyps in patients with gallbladder stones or polyps treated by laparoscopic combined biliary choledochoscopy are long operation time and ethnic minority; the protective factors are good compliance, active postoperative intervention and outpatient follow-up. The long operation time is a reflection of the complexity of the operation and the unskilled surgical operation of the operator. Long operative time is a risk factor for recurrence of gallbladder stones or polyps in patients with gallbladder stones or polyps treated by laparoscopic combined biliary choledochoscopy, which is mainly related to the following factors: 1. Patients with longer operative time have more chances of gallbladder wall trauma, more obvious degree of postoperative gallbladder wall edema, longer recovery time of gallbladder function, and prolonged bile accumulation in the damaged The gallbladder wall that has been damaged for a long time is more likely to form stones and polyps. 2. Those with longer surgery time are more likely to form adhesions with the surrounding tissues after surgery, which cannot be successfully reset, resulting in poor bile drainage, bile stasis, and more likely to develop stones and polyps. 3. If the operation time is long, there are more small stones or polyps left, and after the operation, bile is easily deposited on the remaining small lesions to form bigger stones or polyps. 4. More bleeding from the gallbladder wall in those with long surgery time, and blood clots in the gallbladder after surgery are also one of the triggers of stone and polyp recurrence. Ethnic minorities are risk factors for recurrence of gallbladder stones or polyps after surgery in patients with gallbladder stones or polyps treated by combined laparoscopic choledochoscopic biliary stone extraction or polypectomy. This may be mainly related to the dietary habits of ethnic minorities and early marriage and multiple births. Some ethnic minorities mainly eat meat, and adult Uyghur women are fat as their beauty, and high triglyceride levels are an important risk factor for the development of gallbladder stones and polyps. Moreover, ethnic minorities in most areas marry early and often have more than 2 children, and early marriage and multiple births are predisposing factors for the development of gallbladder stones and polyps. Good patient compliance is a protective factor for the recurrence of gallbladder stones or polyps after surgery in patients with gallbladder stones or polyps treated by combined laparoscopic choledochoscopic biliary stone extraction or polypectomy. Postoperative follow-up and changes in dietary habits require long-term adherence, and only patients with good compliance will be able to persist and thus benefit. The main factors affecting patient compliance are the patient’s willingness to preserve gallbladder, economic level, education level, and health awareness. Only patients who are willing to actively preserve their gallbladders will be able to persist and actively cooperate with our treatment, and our postoperative interventions will be well implemented. For those patients who are not strongly conscious of gallbladder preservation, cholecystectomy is appropriate. Therefore, we are required to assess the patient’s compliance during the preoperative conversation based on the communication with the patient, and to emphasize the probability of stone and polyp recurrence, the risk and postoperative interventions to prevent stone recurrence and the economic burden, and not to recommend the choice of biliary preservation surgery for patients with poor compliance. The adoption of effective postoperative interventions is a protective factor for postoperative gallbladder stone or polyp recurrence in patients with gallbladder stones or polyps treated with combined laparoscopic choledochoscopic biliary stone extraction or polypectomy. Postoperative interventions refer to the adherence to oral ursodeoxycholic acid. Ursodeoxycholic acid promotes the secretion of endogenous bile acids, antagonizes their cytotoxic effects, and protects cell membranes. Ursodeoxycholic acid can also improve bile composition, inhibit cholesterol synthesis to avoid stone formation, and also dissolve cholesterol-based stones, which helps to reduce the recurrence rate of stones or polyps after surgery. Patients must adhere to a regular diet and eat fresh vegetables and fruits after cholecystectomy or polypectomy, as the gallbladder can be stimulated by food to produce regular contraction movements to discharge the accumulated bile outside the gallbladder. Only a moving gallbladder can avoid the formation of adhesions with other tissues, thus not affecting the contraction function of the gallbladder and avoiding the formation of new stones. A change in the pace of personal life and physical exercise are also important. Exercise can improve the metabolic balance of body fat, lower the level of cholesterol in the body and reduce the recurrence of cholesterol stones. Adherence to effective specialist outpatient follow-up is a protective factor for the recurrence of gallbladder stones or polyps in patients with gallbladder stones or polyps treated by combined laparoscopic choledochoscopy or polypectomy. Consistent and effective specialist outpatient follow-up can regularly track the status of the patient’s postoperative gallbladder function and provide timely, active and effective interventions. During the outpatient specialist follow-up, we have a good understanding of the patient’s postoperative recovery and postoperative diet structure and living status through face-to-face conversation based on the review results, and promptly remind and correct the patient’s inadequate work. If the B
ultrasound reveals that the bile is viscous and has small light spots, it is necessary to drink a lot of water and apply antispasmodic drugs appropriately to dilate the bile ducts and promote the discharge of bile on the basis of oral ursodeoxycholic acid. After the above treatment, the tiny dots in the gallbladder disappeared quickly in several patients we met. At the next re-examination, the gallbladder was normal and no stones were formed. For patients with clear susceptibility factors, targeted interventions and increased frequency of review can be developed based on the review, so that recurrent gallbladder stones and polyps can be detected and treated in a timely manner.