A series of 39 cases of gallstone ileus is presented. The median follow-up period was 6 1/2 years (range 4 months-20 years). Surgical treatment was primarily performed in 36 cases. The overall operative mortality rate was 14%. In two cases the initial operation was one-stage enterolithotomy, fistula repair and cholecystectomy. In one of these cases a second operation had to be performed 18 months later, because of choledochal stones. Five of the 29 patients who survived initial simple removal of stone subsequently had biliary-duct related symptoms, all within the first three postoperative years. Re-operation was necessary in only three of these five cases (11% of the series). The study led to the conclusion that initial surgery for gallstone ileus should be limited to removal of obstructing stones. Recent literature, indicating increased mortality following one-stage repair, supports this conclusion.