Between 1971 and 1977, 361 patients underwent early elective cholecystecomy for acute cholecystitis, and the complications and mortality were studied according to the length of time from admission to operation. A substantially greater proportion of the complications, and the only deaths, occurred in the patients operated upon more than 7 days after admission. The mortality rate was 0.6%. Nine additional high-risk patients underwent cholecystostomy. There were four postoperative deaths in this group, all related to the debilitating underlying conditions. The mortality for the entire series was 1.6%. These results compare favourably with those following delayed elective operations for acute cholecystitis. Early elective operation, using cholecystectomy when possible and cholecystostomy when necessary, is recommended for general use in experienced hands. This practice is safe and sound particularly when the diagnosis is made more certain preoperatively by the use of intravenous cholangiography.