Abstract Background Laparoscopic cholecystectomy (LC) is the current gold standard for the management of acute cholecystitis, where ultrasonic dissection and electrocautery dissection are the two primary techniques used, however, it remains uncertain which approach is safer and more efective. Objectives This systematic review and meta-analysis aimed to compare the clinical outcomes of ultrasonic dissection versus electrocautery dissection in LC for acute cholecystitis, particularly in operative time, hospital stay, blood loss, intraoperative and postoperative complications. Method A systematic literature search was conducted in PubMed (MEDLINE), Scopus, Web of Science (WOS), EMBASE, and Cochrane CENTRAL up to January 7, 2025, following PRISMA guidelines. Eligible studies were randomized controlled trials (RCTs) comparing ultrasonic dissection and electrocautery dissection in LC for acute cholecystitis. Data extraction and risk-of-bias assessment were independently performed. Statistical analyses were conducted using Review Manager (RevMan 5.4), with heterogeneity assessed using I 2 statistics and a random-efects model where necessary. Results A total of 28 RCTs, comprising 3383 patients (1720 in the ultrasonic dissection group and 1663 in the electrocautery group), were included. The meta-analysis demonstrated that ultrasonic dissection signifcantly reduced operative time (−9.13 min, 95% CI −9.65 to −8.61, p<0.0001, I 2=97%), hospital stay (−0.95 days, 95% CI −1.74 to −0.17, p=0.02, I 2=100%), and blood loss (−27.60 ml, 95% CI −38.48 to −16.72, p<0.00001, I 2=98%). Subgroup analysis reduced heterogeneity in some outcomes. Risk-of-bias assessment showed variability in study quality, with concerns in allocation concealment and performance bias in certain RCTs. Conclusion Ultrasonic dissection demonstrated advantages over electrocautery dissection for laparoscopic cholecystectomy in patients with acute cholecystitis, including reduced operative time, lower blood loss, and shorter hospital stays. While some heterogeneity was observed among studies, ultrasonic dissection appears to be a safer and more efcient technique.