Background: The results of fifty-eight patients with complicated cholecystitis and high ASA scores treated with percutaneous cholecystostomy or delayed cholecystectomy were analyzed retrospectively. Material and Methods: The patients were divided into two groups according to the surgical interventions as percutaneous cholecystostomy (n:28) and delayed cholecystectomy group (n:30). In group 1, percutaneous cholecystostomy was performed in a single session in 25 patients and repeated twice in 3 patients due to catheter dislocation. Fifteen and 13 patients had ASA III and ASA IV respectively in this group. Results: Laparoscopic and open cholecystectomy was performed in 18 and 8 patients respectively in the second group. The 4 of laparoscopic cholecystectomies were converted to open surgery. All patients had ASA III in this group. Conclusion: Percutaneous cholecystostomy is a safe practice in patients with high ASA scores, most notably in ASA 4 patients and in patients with complicated acute cholecystitis. Delayed cholecystectomy can be performed in ASA 3 patients.