Objective: To compare laparoscopic cholecystectomy (LC) with or without percutaneous transhepatic gallbladder drainage (PTGD) for acute severe cholecystitis. Methods: According to the predefined inclusion and exclusion criteria, 23 articles were selected for this meta-analysis. All patients were treated with LC with or without PTGD. A meta-analysis was used to analyze the clinical efficacy. Results: Compared with LC, all the surgical indicators of LC with PTGD were significantly better than LC alone (all P≤0.05), including the operation time: 95%CI(-27.24, -9.27); intraoperative blood loss: 95%CI(-50.25, -40.19); postoperative hospital stay: 95%CI(-3.63, -0.64); rates of conversion to open abdomen: OR=0.48, 95%CI(0.32, 0.74); rates of incision infection: OR=0.49, 95%CI(0.25, 0.99); drainage tube indwelling time: 95%CI(-2.07, -1.19); gastrointestinal function recovery time: 95%CI(-1.73, -0.77); rates of bile leakage: OR=0.23, 95%CI(0.12, 0.44); and rates of complications: OR=0.36, 95%CI(0.27, 0.48). Conclusion Compared with LC alone, PTGD+ LC is the preferred treatment for acute severe cholecystitis.