Gallstones are the primary benign disease diagnosed and treated in biliary surgery. With the development of medical technology and the increasing awareness of health among the population, the detection rate of gallstones has been increasing annually, with the majority being asymptomatic or mild cases. Currently, the clinical treatment of gallstones mainly includes observation, conservative, or surgical treatment (laparoscopic cholecystectomy). However, there remains some controversy regarding the clinical management of these patients. For asymptomatic or mild gallstones, the main point of contention in both academic and clinical settings is how to determine the indications for cholecystectomy. This article reviews relevant literature from both domestic and international sources, addressing the controversies surrounding the clinical management of gallstones and the determination of indications for cholecystectomy, and elaborates on these issues from multiple perspectives.