From January 1991 to May 1996 a total of 3,010 cholecystectomies was performed for cholelithiasis. Pathohistologically an acute cholecystitis was found in 483 patients (16%). The overall proportion of laparoscopic operations has increased from 12.5% in 1991 to 96.6% at present. In patients with acute cholecystitis the proportion of laparoscopic operations has increased from initially only 1.87% up to 83.3%. The duration of surgery (81 min versus 54 min), rate of conversion (12% versus 1.07%) and rate of complications (7.76% versus 2.2%) were all significantly higher in cases of acute cholecystitis than in those without inflammation. There was no mortality in either group. Furthermore no significant difference was found between patients with histopathologically proven acute inflammation and patients with an acute episode of chronic cholecystitis. The duration of complaints, however, had a significant influence on surgical results. In patients that were either operated on within 48 h after the onset of disease or more than 10 days later, the length of the operation was shorter and the rates of conversion and complications were lower. Our results prove that laparoscopic cholecystectomy is also very successful in cases of acute cholecystitis, though a long learning curve has to be expected. Taking efficiency and economy into consideration, surgery within a few days of the onset of disease must be recommended.