Many gallbladder stone patients have recurrence of gallstones a year or several years after cholecystectomy and need surgery again, and when others hear about this, they lose confidence in this surgery. Some of these patients have stones in the bile ducts at the time of gallbladder removal, but they were not detected because of the small size of the stones; some patients have stones growing in the bile ducts in addition to the gallbladder, which are related to individual differences in people. So why are gallstones easy to recur after gallbladder stone surgery? The most common reasons are: (1) When there are small stones in the gallbladder, due to surgical compression or gallbladder contraction, these small stones can enter the common bile duct from the gallbladder duct before or during surgery. If these small stones remain in the common bile duct, they can cause obstruction of bile drainage over time, which inevitably causes the medical condition called “obstructive jaundice”. Therefore, if small stones are found during cholecystectomy, the common bile duct should be opened and checked for small stones, and if they are found, they should be removed to avoid recurrence of stones after cholecystectomy. In order to find any fine or sediment-like stones, choledochoscopy is necessary during surgery, otherwise there are mostly left behind, especially fine gallstones attached to the bile duct wall. (2) In the natural state, small, multiple stones in the gallbladder are often discharged into the intestine via the common bile duct. Gallstones are continuously expelled and stones are continuously produced in the gallbladder. Pain can occur during gallstone discharge, which can continuously damage the opening between the bile duct and the intestine, and the pancreatic duct that secretes pancreatic juice is also located in this opening, so it can cause acute pancreatitis, and this common opening of the bile-pancreatic duct and the intestine can also be narrowed. In this case, if only the gallbladder is removed, recurrent acute cholangitis or pancreatitis is bound to occur after surgery due to the narrowing of the opening. When this happens, in addition to removing the gallbladder, it is also necessary to perform an enlarged drainage operation at this opening, which is medically called “sphincterotomy”, so as to ensure that even small gallstones can be drained naturally after surgery, and that bile and pancreatic juice can flow freely without causing acute cholangitis or acute pancreatitis after gallbladder surgery. (3) Some patients with gallbladder stones may also have bile duct stones before surgery, which is called hepatobiliary stone disease, and such stones are bile pigment stones, i.e. the above-mentioned sludge or friable gallstones. If only the gallbladder is removed, a series of symptoms will be induced by the inability to discharge stones in the liver or common bile duct after surgery, while no symptoms will occur if the stones are discharged to the intestine in time. Therefore, intraoperative choledochoscopy is used to remove intrahepatic or common bile duct stones in these patients, and internal drainage is also performed to ensure the free flow of regrowing gallstones and bile. Of course, there are many internal drainage procedures, such as choledochoduodenal anastomosis, choledochojejunostomy, sphincterotomy, etc., and one of them can be chosen according to different situations. Whether to make such drainage and which drainage to choose in time play a decisive role in the therapeutic effect of biliary surgery. (4) Irregularity of cholecystectomy surgery is also one of the most common causes of recurrence after cholecystectomy. For example, if the cholecystic duct is left too long in the process of gallbladder removal, the postoperative “cholecystic duct residual overgrowth syndrome” is bound to occur, which is the cause of recurrence of painful symptoms after gallbladder surgery. In conclusion, irregularities in cholecystectomy surgery, failure to explore the bile duct when it should be explored, and failure to perform intraoperative choledochoscopy as a routine; failure to perform early internal drainage of sloughy gallstones, failure to release stenosis of the common biliopancreatic channel or failure to perform additional internal drainage when it should be done are the key causes of recurrence after cholecystectomy.