Asymptomatic gallstones are also called “silent” gallstones. It is true that 80% of gallstones patients remain asymptomatic, but 10% develop symptoms in the first 5 years after diagnosis. The patient’s symptoms can sometimes produce serious complications such as acute cholecystitis, biliary pancreatitis, cholangitis, etc. Once symptoms appear, they will recur and interfere with life. Data show that recurrent gallstones often have an increased chance of surgical complications because of poor adhesions to surrounding structures. Recently, a follow-up study with a large foreign sample found that patients with gallstones had more total costs than the surgical treatment group because of frequent conservative treatment and follow-up observations. So, what kind of gallstones will be symptomatic and require surgery? It is generally accepted that the size or nature of the stones, the thickening of the gallbladder wall, the contractile function of the gallbladder, and the structure of the gallbladder are all important predictors of progression to symptomatic or complicating disease. Patients with stones larger than 2.5 cm have a higher risk of developing acute cholecystitis and gallbladder cancer, for example. In addition, patients with porcelain-like gallbladders and gallbladder polyps larger than 10 mm in diameter are at increased risk of progression to gallbladder cancer. Factors that may contribute to the development of symptoms or complications include the patient’s systemic factors such as age, gender, and diabetes mellitus. Post-bariatric surgery for bariatric disease (30% of developing gallstones) and post-colonic resection (20% will be symptomatic within 5 years) are both high risk factors for developing symptomatic gallstones. Due to advances in laparoscopic cholecystectomy, the risk of elective laparoscopic cholecystectomy has become very low. Therefore there is growing support for prophylactic early surgery, especially early laparoscopic cholecystectomy for stone extraction. In any case, the table is currently accepted as a guideline standard for performing prophylactic cholecystectomy for asymptomatic gallbladder stones. In comparison, if the patient has good gallbladder function, we believe that early laparoscopic cholecystectomy for stone extraction is more valuable, both to prevent complications and to preserve gallbladder structure and function. Criteria for prophylactic cholecystectomy Life expectancy >20 years Stone diameter >2 cm Stone diameter <3 mm and non-occlusive cystic duct X-ray positive stones Gallbladder polyps Non-functioning or calcified gallbladder Women <60 years