Background Acute cholecystitis (AC) is a major complication of gallstones. Laparoscopic cholecystectomy for AC has still not become routine because the timing and approach to the surgical management in patients with AC is still a matter of debate among general surgeons. The aim of this investigation is to clarify the safety and feasibility of the emergency or early laparoscopic cholecystectomy (ELC) for AC in comparison with the interval or delayed laparoscopic cholecystectomy (DLC) regarding procedure safety, operating time, injury to bile ducts, postoperative pain, total length of hospital stay, cost factor, loss of active days of work (days away from work), and conversions to open cholecystectomy. Patients and methods One hundred forty-eight patients were managed by laparoscopic cholecystectomy for AC and were randomized into two groups; the first (early) group (n=74) was managed by ELC and was carried out within 72 h of onset of symptoms, while the second (interval) group was managed by DLC and was carried out at least 6 weeks after symptoms settled. Clinical presentation, duration of symptoms, ultrasound findings, frequency of conversion to open operation, and numbers/types of complications were recorded. Moreover, the statistical analysis was carried out using the Statistical Package for Social Sciences. Results Our study claimed that ELC has a low conversion rate, shorter operative time, postoperative course, and significantly shorter total hospital stay (P<0.001) but longer operation time without an increase in morbidity to the patient. Conclusion Current evidence supports ELC as the preferred treatment strategy for patients presenting with AC. It allows a shorter hospital stay and greater patient satisfaction, but shares similar operative morbidity, mortality, and conversion rate as DLC. Keywords: acute cholecystitis, delayed laparoscopic cholecystectomy, early laparoscopic cholecystectomy