The prevalence of gallstones in Germany is 15–20%. Stones are frequently associated with symptoms and complications and, thus, require medical intervention. During the past decade, several studies were published concerning the timing of treatment for symptomatic gallstones in different clinical settings. Early laparoscopic cholecystectomy (CHE) should be performed within the first 24 h (up to a maximum of 72 h) after hospital admission for acute calculous cholecystitis. Neither the risk of perioperative complications nor the intraoperative conversion rate to open cholecystectomy is higher following this strategy, but the risk of stone-related complications over time is significantly reduced. Severe acute cholangitis is a medical emergency and is associated with a high mortality of up to 10%. Emergent endoscopic transpapillary or percutaneously performed biliary drainage is a life-saving “must” in this situation. For mild acute stone-related pancreatitis, early CHE during first admission is recommended; however, it can be performed during the first 14 days following the hospital stay to reduce complications in the interval to scheduled CHE. The proposed recommendations for timing, which were developed under study settings, require high surgical and endoscopic expertise in clinical routine and well-organized coordination between surgeons and endoscopists.