This study aimed to evaluate the efficacy of vinegar-soaked Ficus carica fruits (VSFCF) for managing cholelithiasis in adults. A parallel-group, single-blinded, randomized controlled trial at Noreen Nishat Welfare Hospital, Khanewal, Pakistan, was conducted from December 2023 to February 2024. Fifty adults with ultrasound-confirmed cholelithiasis were randomly assigned to receive either VSFCF (1 g/kg/day) or ursodiol (600 mg/day). Primary outcomes included gallstone size reduction, while secondary outcomes assessed symptom relief (pain, bloating, digestive discomfort) and hepatic markers. Data analysis was performed using SPSS with a significance level set at P<0.05. Results indicated a significant reduction in gallstone size in the VSFCF group, with mean sizes decreasing from 15.5± 2.3 mm to 7.3±1.0 mm (P<0.001), compared to a decrease from 16.1±2.5 mm to 10.8±1.5 mm (P<0.01) in the ursodiol group. Additionally, VSFCF significantly improved symptoms and hepatic markers, with P-values ranging from <0.05 to <0.001. These findings suggest that VSFCF is an effective alternative for reducing gallstone size and improving symptoms and hepatic health in cholelithiasis management.