OBJECTIVE Although laparoscopic cholecystectomy is the most widely used technique in the surgical treatment of acute cholecystitis, some schools continue to perform the open approach in the treatment of that disease. Our objective is to make a comparative analysis of results obtained with laparoscopic cholecystectomy (LC) and gall bladder removal by open cholecystectomy (OC). METHODS The study includes 249 acute cholecystitis cases operated on between January 2007 to December 2008. Mean age was 60.9 years (+/- 16.6) (21-94 years); 51.8% men and 48.2% women. The diagnosis was made considering clinical, laboratory and echographic findings. There were 217 acute calculous cholecystititis and 32 noncalculous. Surgery was performed as follows: 167 LCs, 64 by OC and 18 percutaneous cholecystostomies (PC). RESULTS The comparative analysis of mortality and morbidity of LC with gall bladder removal by OC showed the following results: mortality (1.19% vs 4.6% p=n.s.), major morbidity (5.3% vs 31.25% p<0.001), lesions of the main bile duct (0.5% vs 3.1% p=n.s.) reoperation (3.6% vs 12.5% p<0.05) and hospital discharge up to 48 hours (69.5% vs 10.9% p<0.001). CONCLUSIONS Laparoscopic cholecystectomy provides superior results to open cholecystectomy, and is therefore the first choice treatment in acute cholecystitis.