Gallbladder stones are a common disease in hepatobiliary surgery, and improper or delayed treatment can have adverse consequences. If you understand the following questions, you will be able to have a good understanding of the situation. Why do gallbladder stones require surgery? First, patients with gallbladder stones often have episodes of biliary colic or cholecystitis, which can be relieved most of the time with a short period of medication. However, if there are repeated attacks, it will affect the patient’s work and life, and the related medical expenses are inevitable. In a small number of patients, stones may enter the common bile duct through the cystic duct and become lodged in the lower bile duct or duodenal papilla, causing cholangitis or even pancreatitis, which may have very serious consequences, even life-threatening. Secondly, some patients with gallbladder stones have lost the normal function of the gallbladder due to repeated inflammatory attacks or stones embedded in the gallbladder duct. Thirdly, gallbladder stones are the main risk factor of gallbladder cancer. Most patients with gallbladder stones have chronic cholecystitis, and long-term chronic inflammatory stimulation may easily induce gallbladder mucosa carcinoma, and about 85% of gallbladder cancers are combined with gallbladder stones. Gallbladder cancer is a highly malignant tumor. Removal of gallbladder in patients with gallbladder stones can help prevent the occurrence of gallbladder cancer. What kind of gallbladder stones are most dangerous? Gallbladder sediment-like stones are most likely to enter the common bile duct and induce cholangitis and pancreatitis. When is the most appropriate time to have surgery? With improved hygiene, most people around us can do routine medical checkups every 1-2 years, and most gallbladder stones are found by patients during a medical checkup B. Doctors usually advise us to operate as soon as possible if the ultrasound shows the following: 1) gallbladder mud-like stones; 2) gallbladder-filled stones; 3) gallbladder stones and chronic inflammation leading to atrophy and non-functional gallbladder. For isolated stones and if the patient has no obvious symptoms, immediate surgery is not necessary and observation and regular review can continue. However, with age, the chance of chronic inflammatory stimulation inducing cancer increases year by year. Meanwhile, elderly patients are often combined with other systemic diseases such as cardiovascular and cerebrovascular diseases, diabetes, etc. Once an attack of acute cholecystitis or pancreatitis occurs, treatment may be very tricky. Thus, patients are usually recommended to have surgery before the age of 60-70. The routine procedure of laparoscopic cholecystectomy is performed under general anesthesia after the completion of the routine preoperative examination, with fasting and preoperative preparation on the morning of surgery. In most cases, the surgery can be completed within one hour. After surgery, patients can eat and move around in about 4 hours, and can be discharged on the same day of surgery or the next day. Most patients do not experience significant discomfort after cholecystectomy. A few patients may experience mild abdominal pain or diarrhea in the early postoperative period, requiring appropriate dietary adjustments and, if necessary, adjunctive medication, and most discomfort will resolve on its own after 2-4 months postoperatively. What are the conditions suitable for biliary stone extraction surgery? Since 1882, when German surgeon Langenbach performed the world’s first cholecystectomy, cholecystectomy has been one of the most common surgical procedures, and so far, no significant impact on the patient’s postoperative life has been found, so laparoscopic cholecystectomy is now the standard procedure for gallbladder stones. In recent years, some doctors in China have started to try biliary stone extraction surgery, which is of great concern to many patients. Usually, the following conditions need to be met for biliary stone extraction surgery: 1) good contractile function of the gallbladder; 2) a small number of gallbladder stones, preferably single stones; 3) clear bile properties in the gallbladder and no sediment-like stones. Although the gallbladder is temporarily preserved, the following disadvantages exist: 1) the operation procedure is more complicated than the standard laparoscopic cholecystectomy, thus the operation time and postoperative hospital stay will be extended accordingly, and the cost will increase accordingly; 2) some patients will have recurrence of stones after the operation and need another operation to remove the gallbladder, and a certain degree of inflammatory adhesions will inevitably arise in the abdominal cavity after the previous operation, increasing the risk of a second operation. (3) after laparoscopic cholecystectomy, patients do not need to take long-term medication, while after biliary stone extraction surgery, in order to prevent stone recurrence, they usually need to take ursodeoxycholic acid for a long time and have regular review, which costs hundreds of yuan per month, and patients need to bear a certain degree of living and economic burden. For this reason, patients are usually not encouraged to undergo biliary stone removal surgery at the PLA General Hospital, Peking Union Medical College Hospital, Shanghai Zhongshan Hospital, Sichuan Huaxi Hospital and other top hospitals in China. If a patient strongly requests to have biliary stone extraction surgery, he/she needs to clearly understand the above mentioned situation.