Abstract Aim To evaluate the safety of emergency laparoscopic cholecystectomy in the treatment of gallstone disease. Methods This was a retrospective, single-centre observational study of 267 patients who were admitted with abdominal pain due to a gallstone related pathology during June 2021 to June 2022. The parameters studied were age, gender, duration of symptoms, previous admissions, investigations, imaging, conservative or surgical treatment, emergency surgery or elective interval surgery, utilisation of dedicated "hot gallbladder list", re-admissions, and re-operations. Results Out of the 267 patients, 163 were female and 104 were male. The median age was 61 with the age ranging from 20 to 96. The median duration of symptoms was 2 days before admission. First-time admissions were 226 and re-admissions were 41. Ultrasound, CT and MRI were done on 188, 123 and 64 patients respectively. 178 patients were diagnosed to have acute calculous cholecystitis, 51 patients had acute gallstone pancreatitis and 38 had biliary colic due to lithiasis. 172 patients were treated with surgery of which 104 were operated on during the same admission, 20 in readmission and 48 as an interval elective surgery. Of the 124 emergency operations, 37 were performed on the dedicated "hot gallbladder list" and 87 were performed on the emergency CEPOD list. 2 patients were re-operated due to post-operative complications. 95 patients were managed conservatively. Conclusions Emergency laparoscopic cholecystectomy is a safe option when performed by experienced surgeons. A dedicated "hot gall bladder list" provides a safe and effective way to reduce the disease burden.