Surgical treatment of acute cholecystitis has always been a great challenge for the surgical profession. There are two methods of cholecystectomy: laparoscopic and open. The first laparoscopic cholecystectomy was performed in 1985. With the development of technology and the training of surgeons, it has been gradually replacing open cholecystectomy, and is becoming the gold standard for the treatment of acute cholecystitis. Many papers point out to the advantages of laparoscopic over the open method. This paper analyzes patients who were operated at the University Hospital Center (KBC) Zagreb, in a three year period (2017. – 2019.), classified as K80.0 and K80.1 according to the ICD-10 classification. The laparoscopic and open method of cholecystectomy were compared, as well as conversions by the following: number of performed procedures, frequency of individual severity of acute cholecystitis according to Tokyo guidelines from 2018, frequency of intraoperative and postoperative complications, duration of postoperative hospitalization. Subgroup of patients in the age group of ≥ 75 years old was additionally analyzed. The Strasberg classification was used to describe bile duct injuries. In total, 274 patients were operated. In 240 (87.60%) patients cholecystectomy was started by laparoscopic method, and out of those 240 patients, conversion was required in 27 (11.25%). 34 (12.40%) patients underwent open surgery. After analyzing data from this paper and data from the literature, it was concluded that laparoscopic cholecystectomy is a superior method in the treatment of acute cholecystitis, that early laparoscopic method shows better results than delayed surgery and that laparoscopic cholecystectomy is safe in the age group ≥ 75 years. The surgeon should decide which method would be appropriate for each patient by preoperative assessment of ASA physical status, Charlson's comorbidity index, risk factors for severe laparoscopy, and risk factors for complications.