Background: Cholelithiasis, or gallstones, is a common surgical disease affecting a significant portion of the population, particularly in older individuals and women. The prevalence of gallstone disease varies globally, with a notable presence in Asian and Western populations. Majority of the patients remain asymptomatic. However, cholecystectomy is the primary treatment for symptomatic gallstones, but post-operative symptom persistence is a common concern. Aim: This study aimed to assess the predictive value of pre-operative symptoms in diagnosing cholelithiasis and to evaluate the persistence of symptoms post-cholecystectomy. Method: The study was conducted at the General Surgery Department of Sharda Hospital, Greater Noida. It included patients diagnosed with gallstones who met the inclusion criteria. Patients underwent clinical examination and investigations. Post-cholecystectomy, patients were followed up at 6 and 12 weeks to assess symptom persistence. Endoscopy was performed on patients with atypical symptoms to rule out other pathologies. Results: Out of 250 patients, 76% presented with pain, 48% with nausea, 21.6% with vomiting as typical symptoms. Atypical symptoms included dyspepsia (20.8%), fatty food intolerance (21.2%), gas bloating (20%), heartburn (16.8%), bad taste (9.6%), and diarrhoea (9.6%). Post-operatively, there was a significant reduction in typical symptoms: pain (11%), nausea (22.5%), and vomiting (20%) (p<0.05). Atypical symptoms also reduced, though changes in gas bloating, bad taste, and diarrhoea were not statistically significant as they remained persistent in more than 75% patients. Conclusion: Typical pre-operative symptoms such as pain, nausea and vomiting have significant predictive value for diagnosing cholelithiasis and show marked improvement post-cholecystectomy. However, atypical symptoms have low predictive value and may persist post-surgery. Patients with predominant atypical symptoms should be thoroughly evaluated to rule out other conditions and informed about the potential persistence of these symptoms before undergoing cholecystectomy.