Cholelithiasis is the most common biliary surgical disease. The clinical symptoms mainly depend on the location of the stones, biliary obstruction, biliary tract infection and other factors, and can be manifested as abdominal pain, fever, nausea, vomiting, jaundice and other features. With the aging of population and the change in dietary pattern, the incidence of this disorder is gradually increasing. Although the diagnosis and treatment technology has been relatively mature, the specific cause and pathogenesis of the formation of biliary stones have not been fully elucidated. Metabolic syndrome related diseases may be closely associated with the formation and development of cholelithiasis. Intestinal dysbacteriosis can induce metabolic changes, and lead to the development of metabolism related diseases. Therefore, cholelithiasis has a close relationship with intestinal microecological imbalance, but the studies on the relationship between intestinal microecological imbalance and occurrence of cholelithiasis are relatively limited, and the action mechanism is still unclear. Here, the authors review the role of intestinal microbiota in the pathogenesis of cholelithiasis, and discuss the future research directions.