Background Gallbladder polyps (GBPs) are increasingly detected on abdominal ultrasound, often incidentally, creating uncertainty regarding their true clinical significance and optimal management. While guidelines recommend surveillance or cholecystectomy based on polyp size and risk factors, the correlation between ultrasound-detected GBPs and true histological polyps remains poorly defined. Methods A retrospective cohort study was conducted at a secondary teaching hospital in metropolitan Brisbane, Australia. All abdominal and hepatobiliary ultrasounds performed between January and December 2022 were reviewed. Patients with ultrasound-reported GBPs were identified, and demographic, radiological, management, and histopathological data were collected. Outcomes included the incidence of GBPs on ultrasound, subsequent management, and histological confirmation in surgically managed patients. Results Of 2,946 eligible abdominal ultrasounds, 114 patients (3.9%) were reported to have GBPs. The median age was 54 years (IQR 42–65), with equal sex distribution. Most polyps were solitary (77.2%) and measured <10 mm (93.0%), with a median largest polyp size of 5 mm (IQR 4–7). Cholecystectomy was performed in 10 patients (8.8%). Histopathological examination confirmed true gallbladder polyps in only 4 cases (40%), while 60% demonstrated no polyp or inflammatory pathology. No cases of dysplasia or malignancy were identified. Conclusion Ultrasound-detected gallbladder polyps infrequently represent true histological polyps and were not associated with malignant pathology in this cohort. These findings highlight the high false-positive rate of ultrasound for GBPs and support strict adherence to risk-based guidelines to minimise unnecessary surveillance and surgical intervention.