Objective: To investigate the choice of surgical timing for acute severe cholecystitis (ASC). Methods: The clinical data of 156 ASC patients undergoing emergency laparoscopic cholecystectomy (LC) or elective LC after percutaneous transhepatic gallbladder drainage (PTGBD) were retrospectively analyzed. Of the patients, 21 cases underwent emergency LC, 89 cases underwent LC within 2 months after PTGBD, and 46 cases underwent LC more than 2 months after PTGBD. The main clinical variables were compared between patients with different surgical timings. Results: In patients undergoing emergency LC compared with those undergoing elective LC after PTGBD, the number of open conversion and total hospitalization cost showed no statistical difference (both P>0.05), but intraoperative blood loss, operative time, length of postoperative hospital stay, time period for postoperative antibiotic administration, number of cases requiring postoperative analgesics and incidence of postoperative complications were all significantly decreased (all P<0.05). No significant differences were noted in all above variables between patients undergoing elective LC at different times after PTGBD (all P<0.05). Conclusion: For ASC, performing early emergency LC is inadvisable, while elective LC within or more than 2 months after PTGBD may be more appropriate.