Gallstone disease is becoming increasingly common in the UK, with one in six people developing gallstones and over 100 000 cholecystectomies being performed annually. The gallbladder stores bile produced by the liver and, in the presence of fat in the stomach, releases bile into the duodenum to promote the emulsification and absorption of fats and fat-soluble vitamins from the small bowel. Although most people with gallstones remain asymptomatic throughout their lifetime, approximately 20% go on to develop complications of varying severity, ranging from biliary colic to ascending cholangitis, which can be fatal if left untreated. Ultrasound is the most reliable investigation for confirming gallstone disease. Cholecystectomy provides definitive treatment of symptomatic disease and is usually offered as a laparoscopic, day-case procedure. This article explores the pathogenesis and management of gallstone disease.