During the last few years our knowledge of the pathogenesis of cholesterol gallstone disease has dramatically changed. Only a decade ago this topic was considered as already explored and scientifically not very interesting. However, with the progress in the field of lipid metabolism, the views on the aetiopathogenesis of cholelithiasis and particularly on its genetic aspects appear to be revolutionary. The predominant pathogenetic factor turned up to be the biliary cholesterol supersaturation, which is influenced by biliary secretion of the three major components of bile – cholesterol, phospholipids and bile salts. During the last years biliary secretion of these biliary lipids has been studied thoroughly and genetic mechanisms leading to the disorder of the biliary lipids homeostasis have been described. These novel aspects are discussed in the review article presented.

        Key words: gallstone disease, gallstones, pathogenesis, aetiology, biliary secretion, biliary lipids, cholesterol, phospholipids, bile salts.