Abstract: Objective To compare the clinical effect of early and elective laparoscopic cholecystectomy in the treatment of elderly patients with acute cholecystitis. Methods Totally 84 elderly patients with acute cholecystitis were divided into early group(treated within 72 hours after onset)and selective group(treated from 72 to 96 hours after onset). The operation time, intraoperative blood loss, first time to bed-off activity after operation, recovery time of gastrointestinal function, hospital stay, postoperative abdominal drainage volume and total hospitalization costs, conversion rate to laparotomy and incidence of postoperative complications were compared between the two groups. Results The operation time, the first time to bed-off activity after operation, recovery time of gastrointestinal function and hospital stay of the early group were significantly shorter than those of the selective group, and the intraoperative blood loss, postoperative abdominal drainage volume and hospitalization costs were significantly less than those of the selective group(P<0.05). The conversion rate to laparotomy in the early group was 2.38%, which was significantly lower than 21.43% in the selective group(P<0.05). The incidence of complications in the early group was 2.38%, which was significantly lower than 19.05% in the selective group(P<0.05). Conclusion Laparoscopic cholecystectomy is effective in the treatment of patients with acute cholecystitis within 72 hours after onset, which can shorten the operation time and hospital stay, reduce the conversion rate to laparotomy and the incidence of complications.