Abstract Aims To continue evaluating our service of index admission laparoscopic cholecystectomy for acute biliary diseases. Methods A retrospective analysis was conducted. All patients who had an index admission laparoscopic cholecystectomy between 2016 & 2021 were identified from the hospital database. Data including demographics, time to diagnostic imaging, surgical technique, complications, re-operation, re-admission and mortality were collected from the hospital clinical information system “Myrddin” and patients’ notes. Results There were 335 patients (male: female 128:207) with median age of 62 years (range 16- 92years) presented as emergency with acute biliary symptoms and had index admission cholecystectomy. The reasons for acute admission were acute cholecystitis (n=205) acute pancreatitis (n=60), biliary colic (n=43) and calcular obstructive jaundice (n=27). The time to diagnostic imaging ranges from same day of admission to 3 days (mean= 0.81 days). Laparoscopic cholecystectomy was done in 333/335 with conversion rate of 1.5% (n=5). Five patients (1.5%) required re-operation because of bile leak. There was no major bile duct injury, no bleeding requiring any intervention. The re-admission rates within one week and within 30 days of surgery were (2.4%) and (0.9%) consecutively. Mean length of in-hospital stay (LOS) was calculated only for patients with acute cholecystitis and biliary colic (n=248) and it was 6.8 days. Mortality over 9 years period was 0.579% (3/518).These results are comparable to the available data from the national and international published data. Conclusions Index admission laparoscopic cholecystectomy is still safe and meets the recommended quality standards. Time to surgery has reduced compared to previous cycle and this led to decrease in LOS.