The debate between biliary preservation and biliary excision has been around for a long time. At present, in terms of medical theory, bile preservation occupies a dominant position, while in practice, bile cutting is still the mainstream. 1, the function of the gallbladder; gallbladder is an important organ of the human body, and it must be used by its parents. The gallbladder has a variety of functions, such as storage and concentration of bile, regulation of bile duct pressure and secretion of immune substances and so on. First, let’s understand the role of bile. The digestion and absorption of food are related to the storage and concentration of bile. The gallbladder mainly stores and concentrates bile, and bile mainly helps digest fat. As you can imagine, without the gallbladder, the role of bile would be greatly affected. In addition, gallbladder removal can cause damage to other organs, such as bile reflux gastritis, significantly higher incidence of colon cancer, and increased incidence of common bile duct stones, all of which are undoubtedly hidden dangers for patients to be haunted by the pain of illness all day long. Of course, there is a prerequisite for bile preservation, that is, the gallbladder is functional. When the gallbladder is atrophied, the wall is thick, the gallbladder is obstructed or there is malignant change, the gallbladder should be removed. In short: if the gallbladder is preserved, it should be preserved, and if it is cut, it should be cut. The most common reasons against gallbladder preservation are: (1) the gallbladder is dispensable; (2) stones are bound to recur after gallbladder preservation; (3) gallbladder cutting is safe. First, let’s start with the first point about the presence or absence of the gallbladder. From the function of the gallbladder above, it is easy to see that the gallbladder mainly stores and concentrates bile, and the bile mainly helps digest fat. With the continuous improvement of people’s living standard, especially after the reform and opening up, people’s diet structure has changed dramatically, and the intake of high-fat and high-protein food has increased a lot (compared with the pre-reform and opening up, I don’t know how many times), so that our demand for gallbladder function has increased dramatically. The gallbladder is not dispensable, on the contrary, its role is becoming more and more important. Secondly, the inevitable theory of stone recurrence in the second point is also untenable. This goes back more than 100 years to the Langenbuch era, when gallbladder stones had complications and the gallbladder was cut, which saved many lives at the time. Since then, some people have tried the biliary stone extraction method, but it was found that the stones recurred soon. There are two important reasons for this: one is that there was no choledochoscope at that time, i.e. the blind man could not remove the stones, and the other is that the gallbladder incision sutures were non-absorbable at that time, thus also leading to the recurrence of gallbladder stones. Today, with the rapid development of science and technology, the recurrence rate of stones has been reduced to about 7% with the new bile-preserving method, and even if it recurs again, it can be taken again, and it is not too late to perform cholecystectomy after the gallbladder has lost its function. The last point of gallbladder cutting safety theory, it is not to say. Complications from biliary tract injury account for 1% of gallbladder removal, and gallbladder removal may affect other organs, producing the chain of adverse effects mentioned above in the function of the gallbladder. To give a superficial example, it is like extracting a tooth only to find that the two adjacent good teeth are damaged for no reason. 3. Minimally invasive definition: The laparoscopic technique is accepted by the majority of patients because of its low trauma, low pain and fast recovery, but the above advantages alone are far from enough. The structure and function of the original organ must be taken into consideration while treating the disease, i.e., the structure and function of the original organ should be retained to the maximum extent, which is the real minimally invasive. For example, today, partial resection is used in the treatment of early breast cancer and bladder cancer to preserve the structure and function of the organ as much as possible, so what reason do we have to remove the gallbladder directly regardless of whether it is good or bad? 4. Timing of gallbladder preservation: “Gallbladder preservation is to protect the gallbladder, not to preserve it.” Academician Huang Zhiqiang scientifically summarized the essence of gallbladder preservation, if we just retain the gallbladder without principle, a part of what should be preserved is preserved, and what should not be preserved is also preserved. Before the gallbladder is severely damaged, the gallbladder is a good gallbladder and the effect of gallbladder preservation is very ideal; while when the gallbladder is severely damaged, the effect of gallbladder preservation is also affected accordingly. Therefore, the earlier the gallbladder is preserved, the better, and the more asymptomatic the patient is, the better (often with mild inflammation and requiring further ultrasound examination). Early treatment can remove the stones and preserve the gallbladder.