Objective To study the safety of laparoscopic cholecystectomy (LC) with low pressure pneumoperitoneum for high risk patients with gallstone. Methods 72 high risk patients with gallstones were undergone LC with low pressure pneumoperitoneum and their clinical data were analysed in our hospital during last three years. Results one of 72 patients was converted into open cholecystectomy due to bleeding, and two of them were converted due to severe adhesion. The others were performed successfully and no serious complications occurred. Conclusions LC is a safe method for high risk patients with gallstone. The key point is to use low pressure pneumoperitoneum during LC.