The earlier the operation is done for acute cholecystitis the better as the tissue planes are inflammatory rather than fibrotic.   There are plenty of meta-analyses and studies showing is safe to operate in the first 3 days of admission with no excess morbidity and much shorter length of hospital stays.  But most importantly this avoids further attacks of pain / sepsis whilst awaiting surgery; its also a more efficient service.  This is provided you have access to emergency theatre and approriate equipment to do the procedure laparoscopically.   Some surgeons extend the indication to the first 7 days of symptoms.    Waiting longer means more difficult surgery, higher rate of conversion, potential injuries to the CBD, bile leaks etc etc.

See these studies; as they may help you:

Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304).

Gutt CN, Encke J, Köninger J, Harnoss JC, Weigand K, Kipfmüller K, Schunter O, Götze T, Golling MT, Menges M, Klar E, Feilhauer K, Zoller WG, Ridwelski K, Ackmann S, Baron A, Schön MR, Seitz HK, Daniel D, Stremmel W, Büchler MW.

Ann Surg. 2013 Sep;258(3):385-93

Ann Surg. 2014 Jan;259(1):10-5. doi: 10.1097/SLA.0b013e3182a5cf36.

Comparative operative outcomes of early and delayed cholecystectomy for acute cholecystitis: a population-based propensity score analysis.

de Mestral C1, Rotstein OD, Laupacis A, Hoch JS, Zagorski B, Alali AS, Nathens AB.

Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis.

Gurusamy KS, Davidson C, Gluud C, Davidson BR.

Cochrane Database Syst Rev. 2013 Jun 30;6

Comparison of laparoscopic cholecystectomy for acute cholecystitis within and beyond 72 h of symptom onset during emergency admissions.

Zhu B, Zhang Z, Wang Y, Gong K, Lu Y, Zhang N.

World J Surg. 2012 Nov;36(11):2654-8

Is early laparoscopic cholecystectomy for acute cholecystitis preferable to delayed surgery?: Best evidence topic (BET).

Skouras C, Jarral O, Deshpande R, Zografos G, Habib N, Zacharakis E.

Int J Surg. 2012;10(5):250-8.

Earlier surgery is preferred , probably within 48-72 hrs.

Thanks Dr Ewen A Griffiths

Thanks Dr Muhammad Rafaih Iqbal 

we have fairly large experience with AC chole.It is our routine practice to operate within 24 to 48 hours.Technically easy,no increase in the rate of complications,we discharge them in 24 hours time thus reducing the costs.Majority of them require a drain,and extraction port needs to be extended in some as GB is big,Specimen has to be removed in a bag.What use to be the practice before "cooling the Hot GB"is not necessary.No special equipment is required and is our practice to routinely use Ultracison for all cases to reduce time.

Dr. Taha:

The lapse time from onset of acute calculous cholecystitia is not a correct parameter to decide if the cholecystectomy should be performed or not, although this is universally used, even in randomized studys or evidence based reviews.

My question to the acute calculous cholecystitis you mentioned is that is it an acute symptomatic cholecystitis or pathologically proven acute cholecystitis? 

In the former group, even in the same lapse day, the severity of acute inflammation may differ. There is always 20~30% difficult GB in each lapse group up to > 29 days, except < 3 days group (p

This is hugely controversial. Literature is rich with studies recommending operation within 24 hours, 48 hours, 72 hours, 4 days, 5 days or even  a week or more after the onset of symptoms (not from admission day). Most authorities consider 72 hours as the limit. The limitation is the severity of inflammation. The problem is that history given by the patient may not be exact as patients tend to count from the starting of severe pain. Also patients differ in their inflammatory reactions. I agree with Dr. Yu-ChungChang that inflammation status should be implemented to decide upon this question. I propose a diagnostic laparoscopy with intention to abort if the situation is considered too unsafe for either laparoscopic or open operation since the risk of complications is high in both types of operation. Patients should be well informed of the risks involved and of your plans in all cases.

Is there any published article describing scientifically the improving evidence of inflammation changes after 6-8 weeks delay (elective surgery)? inflammation status before and  after delayed LC? If there is none, why so many surgeons favor delayed LC?

To answer this question a comparison study of inflammation status is necessary, if Dr. Shallaly is going to perform diagnostic laparoscopy. 

With accumulation of data, we will then be able to find a scientific answer. 

attached is my article, which has been repeatedly rejected by the major surgery journals, to answer the question of Dr Taha.

Inflammation status of each case of acute or chronic cholecystitis is different  and hence there is no definite lapse can be followed to guide the operation timing; however, I propose to do LC before the fibrosis formation of Calot's fibrosis. Iatorgenic delay, which may cause fibrosis, should be avoid.