Pediatric gallstone disease is on the rise in the United States, for two main reasons. First, improved diagnostic tools including high-resolution ultrasound have made the detection of small stones more readily apparent. Secondly, dietary changes have led to an increased incidence of cholesterol stones. Additionally, improved survival in the neonatal population, many of whom are maintained on parenteral nutrition for an extended period of time, has led to pathophysiology previously seen in very limited instances. Laparoscopic cholecystectomy remains the standard operation of choice for patients requiring surgical extirpation of the gallbladder alone. Regional variation in expertise dictates the management of choledocholithiasis using either laparoscopic common bile duct exploration or endoscopic retrograde cholangiopancreatography.