Seventy-seven children less than 19 years old underwent cholecystectomy during a 12-year period at UCLA Medical Center. Forty-four had calculous cholecystitis; five had acalculous cholecystitis; and 28 underwent cholecystectomy with other major biliary surgery. In more than half of the patients with calculous cholecystitis, a cause for cholelithiasis could be identified, most commonly total parental nutrition use. Those without an identifiable etiology were all females, were older, were generally obese, had a family history of gallbladder disease and had a higher likelihood of adult-life symptomatology. Cholelithiasis was best demonstrated by ultrasound and oral cholecystogram. Children with biliary atresia, choledochal cysts and other anomalies of the extrahepatic biliary system will benefit from cholecystectomy associated with reconstruction of the ductal system. Mortality and low morbidity were not related to cholecystectomy.