Objectives and background: The aim of this study was to examine the changes in frequency of cholecystectomies performed in the last twenty years, and to use these data to indirectly determine the trends in the incidence of cholelithiasis in children. Another aim was to establish the epidemiological, demographic and clinical characteristics of children who underwent cholecystectomy. Patients and methods: The case records of 45 children who underwent cholecystectomy due to cholelithiasis at the Department of Pediatric Surgery of University Hospital of Split from January 1998 until December 2017 were retrospectively reviewed. The patients were divided into two groups (children who were operated on between 1998 and 2007 and children operated on between 2008 and 2017) and compared by demographic and anthropometric data, clinical findings, indications for surgery, procedure type and treatment outcomes. Results: The number of cholecystecomies performed on children has increased from 11 in the period 1998-2007 to 34 in the period 2008-2017 (p=0.002). The median age of operated children has risen from 11 to 15.5 years (p=0.001) and the average BMI has increased from 19.2 cm/m2 to 23.0 cm/m2 (p=0.012). The share of hereditary spherocytosis within the indications for cholecystectomy has decreased from 63.6% to 11.8% (p=0.0005) in favour of the diagnoses that are etiologically related to cholesterol stones, whose proportion has increased from 27.3% to 70.6%, according to spectroscopic analyses (p=0.006). The frequency of laparoscopic cholecystectomy has increased from 36.4% to 85.3% (p=0.0005) and, consequently, the average duration of postoperative hospital stay has shortened from 8 to 4 days (p=0.008). Conclusions: The number of cholecystectomies in children has increased threefold in the last twenty years and the average BMI of operated children is significantly higher in the last ten years compared to the BMI in the ten years before that, which means that there is a correlation between the rising obesity rates in pediatric population and the increase in frequency of symptomatic cholelithiasis in children.