Laser lithotripsy is strongly undesirable At the lower end of the bile duct near where the bile duct enters the duodenal intestinal lumen, that is, within the duodenal papilla, there is a particularly fine structure called the oddi sphincter, which acts as a valve to allow the bile in the bile duct to enter the duodenum smoothly, but the intestinal contents in the duodenum cannot flow backwards and can prevent bacteria from entering the biliary system. Small stones in the bile duct need to pass through the common bile duct and then through the duodenal papilla (containing the oddi sphincter) below it to drain into the duodenum and enter the intestine, while the pancreatic duct is co-opted with the common bile duct and then secretes pancreatic juice through the duodenal papilla. If the stone falls in the bile duct, acute cholangitis will occur, and in particularly severe cases, infectious shock may occur before it reaches the hospital, and the condition can progress rapidly and be life-threatening in less than twelve hours. If the pancreatic duct is blocked again, there will be an acute attack of pancreatitis, and acute pancreatitis combined with bacterial infection, the mortality rate can reach 20-30%, which is very alarming. Small stones may also fall through the bile duct into the duodenum and these symptoms do not occur. However, the crushed stone is often discharged through the common bile duct and the oddi sphincter, and the structure of the oddi sphincter is destroyed and loses its function, at which point bacteria from the intestine enter the bile duct, and the patient develops recurrent cholangitis, causing biliary liver damage and cirrhosis. If laparoscopic surgery can really be disregarded in the short term, the most effective conservative method is to avoid oily foods to prevent attacks. Xing Tonghai of the General Surgery Center of Shanghai First People’s Hospital does not advocate “biliary stone removal”. Taking the most common gallbladder stone as an example, the most recommended minimally invasive surgical method is laparoscopic cholecystectomy. However, many patients have concerns about removing the gallbladder, thinking that the body cannot secrete bile after the removal of the gallbladder, so they hope to be able to “save the gallbladder to remove the stones”. In fact, bile is secreted by liver cells, and the gallbladder only plays a role in storing bile. After the gallbladder is removed, the bile ducts will be partially dilated and play the role of storing bile. The biggest problem with “gallbladder removal” is that it leaves a gallbladder that has little function and is injured again, which will only grow stones and become inflamed again, which is worse than not having an operation. Doctors take the time to separate the gallbladder from the bile ducts and liver and then remove it, which is much more complicated and risky than opening the gallbladder and taking out the stones to sew it up, so why should doctors take the risk? It is still for the good of the patient. In the 1960s and 1970s, we tried to treat patients with gallbladder stones, and very few of them had good results, but statistically speaking, only a very small percentage had good results. Those who had good results were usually patients with single stones, normal gallbladder function, no stones embedded in the abdomen or neck of the gallbladder, and no sensation without surgery. But nowadays, people live longer, and gallstones without symptoms can cause gallbladder cancer even if they rub against the gallbladder epithelium for twenty or thirty years, and the one-year survival rate is less than 1% if cancer occurs. What’s worse, the vast majority of gallstones recur soon after surgery, and reoperation will be more difficult because of adhesions from the previous surgery. In the last three decades, this simple approach has been abandoned internationally. The reason why “gallbladder removal” is prone to recurrence is that the gallbladder stones themselves grow out, and although the original stones are taken out, the metabolic mechanism in the body has not yet changed, and the epithelium of the gallbladder is still inflamed, and the incision in the wall of the gallbladder is the main site of recurrence of gallbladder stones. Nowadays, laparoscopic cholecystectomy is less traumatic and the operation time is short, we can usually finish the operation in half an hour to one hour, and the patient recovers quickly after the operation, and can be discharged from the hospital in two days after the operation. So, what should I pay attention to after laparoscopic cholecystectomy? We generally recommend that patients’ diet within two weeks after surgery should be gradually transitioned from semi-liquid to general diet, from light and slightly protein to normal diet, otherwise, beyond the body’s digestive and absorption range, the gastrointestinal tract is prone to spasmodic pain, diarrhea and other discomforts.