Background and Aims Cholecystoenteric fistula (CEF) is a rare complication of gallbladder disease that is difficult to diagnose and complex to treat. Therefore, this study was performed to explore its clinical diagnostic methods and treatment approaches by summarizing and analyzing cases of cholelithiasis complicated with CEF that the authors treated.Methods The clinical data of 21 patients with cholelithiasis complicated by CEF who underwent surgical treatment in the Department of General Surgery of the First Affiliated Hospital of Soochow University from January 2019 to December 2023 were retrospectively analyzed.Results Among the 21 patients, 14 had cholecystoduodenal fistula, 3 had cholecystocolonic fistula, and 4 had cholecystogastric fistula. Two cases of cholecystoduodenal fistula were diagnosed before the operation. All patients were scheduled for elective laparoscopic surgery, with 11 completing laparoscopic surgery and 10 converting to open surgery. The size of the fistulas ranged from 0.15 to 3.0 cm, with an average of (0.75±0.70) cm. The duration of surgery ranged from 89 to 270 min, averaging (169±50) min. Intraoperative blood loss ranged from 10 to 200 mL, with an average of (58±63) mL. Postoperative hospital stay ranged from 1 to 90 ds, with a median of 7 ds. The time to postoperative removal of the abdominal drainage tube ranged from 2 to 90 d, with a median of 7 d. The time to resume liquid diet after the operation ranged from 1 to 15 d, with a median of 3 d. Compared to conversion to open surgery, laparoscopic surgery had advantages in reducing intraoperative blood loss, shortening surgery duration, and reducing hospital stay. One patient experienced a postoperative wound infection, which was treated and cured with debridement and suturing. Another patient developed acute myocardial infarction postoperatively and recovered after treatment in the ICU. No patient deaths occurred. During the follow-up period of 5 to 12 months (mean 11 months), no complications such as bile leakage, intestinal leakage, biliary infection, or intestinal obstruction were observed.Conclusion For patients clinically suspected of having CEF, combining the patient's medical history with appropriate use of CT, MRCP, and other imaging techniques can help improve the preoperative diagnosis rate of this condition. In terms of treatment for CEF, the principle involves the complete removal of the diseased gallbladder and fistula, along with the repair of the fistula opening. Selective laparoscopic surgery for treating CEF is safe and feasible.