In the last 15 years we operated on 618 patients for acute cholecystitis, of whom 60 were 80 years of age or more. Most of the ever-increasing number of patients within the hospital population who suffer from this disease belong to the over-80 age-group. Acute biliary complications are the major cause of serious morbidity in these patients. The major conclusions of the study were: (1) Acute cholecystitis in patients aged 80 years or more has increased by almost 300% over the last 15 years. (2) Comparison of patients aged 80 years or more with a younger patient group showed that the former had a higher incidence of diabetes mellitus (33.3 vs. 5.5%, p < 0.001), jaundice (26.6 vs. 14.8%, p < 0.001), common bile duct stones (41.6 vs. 21.1%, p < 0.001) and gangrenous changes in the gallbladder wall (38.3 vs. 24.9%, p < 0.05). Older patients also had higher mortality (11.6 vs. 1.6%, p < 0.001). The results in this series show a higher rate of risk factors in aged patients suffering from cholecystitis combined with a higher rate of mortality. It seems that a prompt operative approach could lessen the grave results in this group. Alternative nonsurgical methods should, at present, be restricted to very poor-risk patients as well as patients refusing surgery.