In patients with acute calculous cholecystitis, early laparoscopic cholecystectomy is the first choice, including high risk patients. The ideal timing is surgery within 72 hours of the onset of symptoms, and the duration of the symptoms should not exceed 7–10 days. If surgery is contraindicated, percutaneous or endoscopic gallbladder drainage may be considered. Team experience and technical equipment of the unit play an important role in the choice of the most appropriate procedure.