BACKGROUND Aims and objectives -A rise has been noted in the incidence of gallstone disease and their associated complications. This clinical study was conducted with the aim of analysing the various aspects of gall stone diseases focusing on the timing of surgery, and intraoperative biliary sampling correlated to the complication rates in acute calculous cholecystitis. MATERIALS AND METHODS50 cases of acute calculous cholecystitis were evaluated with respect to incidence, clinical presentation, comorbidities, timing of surgery, operative difficulty, post-operative complications, hospital stay, bile culture, histopathology and stone analysis. RESULTSThe overall incidence of gall stones in patients was 0.7% of all hospital admissions. The mean age group was 43.92 years with a female to male ratio of 2.13:1. Right hypochondrial and epigastric pain were the most common presenting complaints. Preoperative evaluation with ultrasonogram showed a good correlation with the per-operative findings in 80% of cases. All cases underwent laparoscopic cholecystectomy. Operative difficulty was least when surgery was done within three weeks from the time of presentation. 24% cases had intra-operative complications. Escherichia coli was the most common organism grown in bile culture and there was a statistical significance between positive bile culture and post-operative complications. Pure cholesterol stones were less common on histopathological examination. CONCLUSIONEarly surgical intervention in cholecystitis reduces complications, length of hospital stay and relapse of symptoms during waiting period for surgery. The study suggests routine sampling of bile for bacterial culture and stone analysis in all cholecystectomy cases.