Obesity is a risk factor for operative treatment. This study examined the impact of obesity and associated comorbidities on complications after laparoscopic cholecystectomy (LC). Altogether, 1581 consecutive patients with symptomatic gallstones underwent LC between the years 1995 and 2008. Preoperative data and operative outcome of the 437 obese patients [302 with body mass index (BMI) 30 to 35 kg/m² and 135 with BMI ≥ 35.1 kg/m²] and 1144 nonobese controls (BMI ≤ 29.9 kg/m²) undergoing LC were compared. The impact of obesity, diabetes, cholecystitis, coronary heart disease, pulmonary disease, hypertension, and renal insufficiency on the postoperative outcome was analyzed by using multiple logistic regression analysis. The percentage of obese patients undergoing LC did not change during the study period. Over half of obese patients (63%) had 1 or multiple comorbidities, but only 15% of the patients had an acute surgery because of cholecystitis. Conversion to open surgery was required in 11.7% of the obese patients compared with 6.1% in the nonobese controls (P=0.0003). Acute cholecystitis increased the conversions in class II and III obese patients (50%) compared with elective surgery (8.7%, P<0.001). Mortality rate was 0 in obese patients and the rate of complications, except surgical site infections, comparable with nonobese patients. In multivariate analysis, obesity or any of the comorbidities did not associate with an elevated risk for postoperative complications. In symptomatic gallstone disease, obesity and related comorbidities increased the conversion rate, but not the operative risks of LC.