The indication for surgery for bile duct stones depends on whether the stone is an extrahepatic or intrahepatic bile duct stone. Extrahepatic bile duct stones are usually indicated for surgery because they are located in the common bile duct and if they cause obstruction, they will prevent bile from draining and cause severe symptoms. For extrahepatic bile duct stones with corresponding indications, ERCP can be considered for stone extraction; for larger and more serious stones, surgical excision can be considered for stone extraction if ERCP has limitations. For asymptomatic cases, elective surgery can be considered, while for those with less severe symptoms but larger or more stones, or those with acute cholangitis or even more severe acute obstructive purulent cholangitis, emergency surgery is required for incision, drainage and stone extraction. Intrahepatic bile duct stones: If the number of stones is not large and does not cause serious symptoms, they can usually be observed first. The indications for surgery for intrahepatic bile duct stones are mainly for recurrent inflammatory episodes of the intrahepatic bile duct, or atrophic stenosis of the bile duct, distant bile duct dilatation, or recurrent cholangitis or biliary tract infection causing local atrophy and fibrosis of the liver tissue, or the risk of cancer due to stones cannot be excluded, or combined with obstruction of the common bile duct stones. Further surgical treatment needs to be considered for intrahepatic bile duct stones in these cases. In conclusion, the need to consider surgery for bile duct stones depends on the individual circumstances of each person. The indication for surgery is only a preliminary direction to grasp, as the specific site, size, and number of stones, as well as the presence of combined serious complications, vary from person to person. Theoretically, the patient has to undergo surgery to achieve the goals of stone removal, drainage, infection control, and stenosis relief.