SUMMARYIn a review of 157 patients admitted to hospital as emergencies with acute gall-stone disease it was found that 52 cases (33.1 per cent) had undergone definitive operation for gall-stones during the emergency admission in spite of an overall conservative policy in relation to operation. The results of these early operations are compared with those of operations delayed to a second admission in other patients of this series. There was no significant difference in mortality or morbidity, but there was a saving on average of 5 days in hospital for those patients who were operated on at the first admission.THE clinical manifestations of gall-stones can properly be referred to as 'gall-stone disease'; in this account we confine ourselves to manifestations arising in the biliary tract, thereby excluding the extra-biliary complications of pancreatitis and gall-stone ileus.In the management of any acute episode of gallstone disease conservative treatment is commonly preferred, no matter whether inflammatory or mechanical factors predominate. The policy of conservatism, aimed primarily at inflammatory disease, derives from the early part of this century and has been described as reserving surgical intervention within the first few days for uncertain diagnosis or uncontrolled infection (Till, 1963); acute symptoms usually subside, and operation necessary to deal with stones is planned as a delayed elective procedure at a later date. This view is based on the premiss that operation during the acute phase may be difficult or even dangerous; as a policy it succeeds in that the resulting mortality is generally low. Nevertheless, the timing of operation remains controversial and many have argued that early definitive operation without planned delay will avoid a waiting period, which is not entirely free from further painful attacks, and allow the patient to resume a normal life sooner; if operation is carried out in the first few days symptoms are at once abolished and further spread of inflammation beyond the gall-bladder is prevented (Devine, 1940;Glen and Thorbjarnson, 1963;Smith and Sherlock, 1964;Essenhigh, 1966;Payne, 1969; Van der Linden and Sunzel, 1970). It cannot be denied that these are strong arguments against delay.The management of our own patients has been based on a conservative policy. Even so, considerable numbers of patients for various reasons have had early operation, defined here as operation during the emergency admission. We have compared the results in these patients with the results in those treated conservatively followed by delayed operation at a later admission in a group of patients all of whom were admitted initially as emergencies. If early operation is fraught with difficulties its results might be expected to compare poorly with delayed operation when a conservative policy is in operation, because patients selected for early operation will tend to be those in whom the disease is worse and has failed to respond to conservative management. It is not intended to suggest that all cases of ac...