Laparoscopic cholecystectomy (LC) has become one of the options for the treatment of acute cholecystitis as surgeons gain facility with this procedure. However, acute suppurative cholecystitis is still a severe condition, because a high mortality rate still exists. In the early years (1991 to 1992), 4 patients were operated on without a preceding percutaneous transhepatic gallbladder drainage (PTGBD) at our hospital, however, one patient died of septic shock after a laparoscopic cholecystectomy. Conversion to open surgery was performed on two patients. However, in later years (1992 to 1995), 14 patients were operated on with preceding PTGBDs safely. Here, we report the safeness and significance of the combination therapy of PTGBD and LC for patients with severe acute suppurative cholecystitis.