Acute cholecystitis as a rule requires operative treatment. When it occurs as a complication of gall stone disease, early cholecystectomy within two to three days has been accepted as a safe procedure. If possible, the laparoscopic approach should be preferred. In cases of technical difficulties conventional open cholecystectomy should be planned as a primary approach or be performed by conversion of the laparoscopic approach. Cholecystostomy performed as an interventional procedure is indicated in high-risk patients due to comorbidity only. For acalculous cholecystitis, however, this approach is regarded as the initial procedure of first choice.