To evaluate patients with gallbladder polyps and to compare them with patients with chronic acalculous cholecystitis, 301 patients with chronic acalculous disease of the gallbladder, of which 45 had polyp disease of the gallbladder, were reviewed out of 7181 cholecystectomies performed from June 1985 through June 1995. Of the 45 patients, 30 (Group A) were diagnosed preoperatively by ultrasound and 15 (Group B) postoperatively on pathologic examination. In each group, the most common polyp was cholesterol type (19/45) with multiple lesions in 10 of these 19 patients. Chronic cholecystitis was present elsewhere in the gallbladder in 40 per cent of Group A and 80 per cent of Group B patients (P = 0.02). Forty-three patients had polyps less than 5 mm in diameter, one a 1.5-cm gallbladder cholesterol polyp, and one a 1.3-cm tubulovillous polyp with a focus of carcinoma in situ. During this same period, 17 patients had primary malignancy of the gallbladder, none of which were found in polypoid lesions. In Group A patients there were significantly fewer preoperative tests than in typical acalculous patients [2.3 versus 3.8 (P<0.03)], including upper endoscopy (P<0.02) and hepatobiliary scintigraphy (P<0.00001). Of the patients with polyps, 42 of 45 (93.3%) had resolution of symptoms postoperatively with a mean follow-up of 178.9+/-505.0 days (range 1-2438 days). Most patients with biliary tract symptoms and a small (<5-mm) gallbladder polyp underwent fewer preoperative diagnostic tests than patients with chronic acalculous cholecystitis. This abbreviated preoperative workup appears warranted in view of the high incidence of symptom resolution.