Objective: To explore the clinical efficacy and safety of laparoscopic surgery for acute cholecystitis (AC) in elderly patients. Methods: From January 2006 to May 2012, 138 elderly patients with acute cholecystitis were randomly assigned to undergo laparoscopic cholecystectomy (laparoscopic group, n=70) or open cholecystectomy (open surgery group, n=68). The operative time, time span for bowel function recovery, length of postoperative hospital stay and incidence of complications of the two groups were compared. Results: Except for the similarity in the intraoperative blood loss (P>0.05), the operative time, time to intestinal function recovery and length of postoperative hospital stay were all significantly reduced in laparoscopic group compared with open surgery group (all P<0.05). The incidence of complications of laparoscopic group was also significantly lower than that of open surgery group (P<0.05). Conclusion: Laparoscopic surgery has ideal effect for acute cholecystitis in the elderly, and the successful treatment depends on the choice of the surgery timing and surgical expertise.