The gallbladder should be preserved In terms of gallstone surgery, there is a long-standing academic debate between removal of the gallbladder (cholecystectomy) and preservation of the gallbladder (cholecystolithotomy). The theory of cholecystectomy is based on the “hotbed theory” created by German physician Langenbuch in 1882, which believes that the gallbladder is a “hotbed” for stone formation and must be removed in order to cure gallbladder stones. But is cholecystectomy really a perfect treatment? Prof. Ran Ruitu, Prof. Wang Xunying and Academician Huang Zhiqiang, the old-timers of biliary surgery in China, have all disagreed with the “hotbed theory”. If it is said that more than 100 years ago, doctors were limited to remove the gallbladder to save the lives of patients, then with the rapid development of endoscopic technology in the past 20 years, doctors’ vision has been extended to all cavities of the human body, can we still ignore the many drawbacks of gallbladder removal? Practice has confirmed that there are various sequelae after cholecystectomy, including: 1. dyspepsia; 2. digestive reflux : reflux gastritis, reflux esophagitis; 3. increased incidence of common bile duct stones; 4. increased incidence of bile duct injury; 5. increased incidence of colon cancer; 6. post-cholecystectomy psychological disorder; 7. post-cholecystectomy syndrome. The gallbladder has an immune function, and the long-term effects of gallbladder removal are worth studying. Changing lipid metabolism and improving bile composition are more important than removing the gallbladder. The gallbladder can be preserved After years of minimally invasive laparoscopic and choledochoscopic techniques for gallbladder stone treatment, it is confirmed that the recurrence rate of gallbladder stones is low after endoscopic biliary stone extraction, and it also significantly improves the quality of life of patients. Indigestion, bloating and diarrhea, reflux gastritis, and increased incidence of common bile duct stones, which are often seen in patients who have had their gallbladders removed, were significantly reduced. Long-term follow-up confirmed that the recurrence rates were 0.49%, 7.21% and 10.11% at 1, 5 and 10 years after surgery, respectively. No need to worry about gallbladder cancer Since endoscopic biliary surgery has many advantages, there are still many people who insist on removing the gallbladder for a long time, one of the reasons is that they are worried about the possible cancer of the gallbladder after preserving it. Prof. Zhang Baoshan et al. followed up 1008 patients after endoscopic biliary stone removal, and no one case of gallbladder cancer occurred. Studies in many other hospitals have also yielded similar results. A large amount of data shows that the recurrence rate of stones after endoscopic biliary stone extraction is not high, and the risk of gallbladder cancer is not higher than that of the normal population. ”How to prevent stone recurrence after “biliary preservation” Due to the limitation of technology, the old style of biliary preservation lithotripsy in the early days did not use fiberoptic cholangioscope to thoroughly explore the gallbladder, so the operator could not see or only partially see the gallbladder cavity at all. This is “blind” stone extraction. The small stones and the debris produced by the lithotripter are left in the gallbladder, and the fine stones grow slowly and are mistakenly thought to be “stone recurrence”, but in fact they are “stone residue”! The biggest difference between laparoscopic endoscopic choledocholithotomy and old-fashioned choledocholithotomy is the skilled application of fiberoptic choledochoscope. The fiberoptic choledochoscope overcomes the blind spot of traditional surgery and can be bent and illuminated at will in the gallbladder cavity, so that the real face of the lesion inside the gallbladder can be seen. After removing the stones, the gallbladder is closed with absorbable sutures in one phase, and the gallbladder sutures can be gradually absorbed without leaving traces after the gallbladder heals. This procedure is less traumatic, with quick recovery and preservation of gallbladder function.