We recently performed a successful laparoscopic biliary stone extraction for a British patient with acute cholecystitis and gallstones. The patient was a 46-year-old female who came to the hospital with 12 hours of right upper abdominal pain. Ultrasonography revealed gallbladder stones with an acute attack of cholecystitis. On blood examination, the leukocytes were elevated. We recommended early laparoscopic cholecystectomy. However, the patient strongly requested a trial of gallbladder preservation. Intraoperatively, gallbladder edema was found to be obvious, but adhesions were not heavy, and there was not much peritoneal fluid leakage. According to the patient’s preoperative request, we did laparoscopic cholecystectomy with hesitation. The patient recovered well after surgery and was discharged two days later. A follow-up visit one week later revealed precipitation in the gallbladder, which was treated with medication and dietary modification. The patient had no discomfort. After one month of treatment, the patient had no discomfort. Gallbladder function tests were performed. There was no stone in the gallbladder in fasting, and the gallbladder contracted more than 80% one hour after the high-protein meal, which means the gallbladder function is intact! The next step is the dietary adjustment to prevent recurrence. Insights from this case: 1. The possibility of biliary preservation exists with early surgery for acute cholecystitis; 2. Postoperative follow-up observation and measures to prevent recurrence are very important; 3. Patient cooperation is needed in preventing recurrence.