The application of laparoscopic cholecystectomy (Lap. C) for acute cholecystitis (AC) remains controversial from the viewpoint of its higher rate of morbidity, and conversion to open surgery, in spite of the worldwide acceptance of Lap. C as the gold standard for the treatment of patients with symptomatic gallbladder diseases. The conversion rate has been reported to decrease with experience. Local and overall complication rates were shown to correlate with the time delay between the onset of acute symptoms and the operation. Although percutaneous gallbladder drainage (PGBD) has been reported to be a safe and effective procedure for the treatment of AC, it should be limited to high-risk groups such as elderly or critically ill patients. Early cholecystectomy within 4 days from the onset is strongly recommended to minimize surgical complications and to increase the chance of a successful laparoscopic approach.