AIMS: To determine the nature and incidence of gallstone-related complications arising in patients awaiting laparoscopic cholecystectomy and to formulate a strategy to detect those most in need of urgent intervention. PATIENTS AND METHODS: A retrospective analysis of the case notes of 337 consecutive patients undergoing laparoscopic cholecystectomy under a single surgeon in a district general hospital between 1995 and 1999. RESULTS: Of patients awaiting laparoscopic cholecystectomy, 65 (19.3%) were documented as suffering significant on-going symptoms, of whom 19 (5.6%) required hospital admission or urgent surgical review at median 8.9 weeks (range 0.1-32.3 weeks) after being placed on the waiting list. Factors predictive of symptom recurrence included: (i) initial acute presentation; (ii) diagnoses of jaundice, pancreatitis, or acute cholecystitis; (iii) elevation of amylase or liver function tests; and (iv) small stones on ultrasonography examination. CONCLUSIONS: A significant proportion of patients awaiting laparoscopic cholecystectomy experience stone-related complications requiring hospital admission. We feel it is possible to reduce this number by selecting those most at risk on the basis of their history and pre-operative investigations for more urgent intervention.