Pathogenesis of gallstones (GS) involves a complex interaction between multiple genetic and exogenous risk factors. As the prevalence, disease burden, aetiopathogenesis, and the complications of GS disease vary across different populations, a better understanding of the disease, specific to a given community is imperative. Though some of the initial studies reveal a higher incidence of pigment and mixed cholesterol GS over pure cholesterol stones among Sri Lankans, GS disease is largely underexplored in local context. Therefore, the prevalence, disease burden and aetiological factors of the GS disease in Sri Lanka need to be rigorously studied. Further research on exploring the possible factors triggering the development of GS on a pigment nidus is essential in discovering the aetiopathogenesis of GS among Sri Lankans and will be the key in identifying effective preventive measures.