Background: abdominal pain is a common complaint seen in emergency departments in United States. Abdominal pain is the leading reason for visits to the emergency department (ED), accounting for 6.8% of all visits in 2006. Aim of the Work: this study aimed to evaluate the diagnostic role of laparoscopy in acute abdominal conditions and its therapeutic role in perforated peptic ulcer, acute cholecystits and acute appendicitis. Patients and Methods: this study was conducted prospectively on 40 patients presented with acute abdomen to AlAzhar University hospitals from March 2018 till August 2018. 24 (60%) of patients were females and 16 (40%) were males. The age ranged from 20 to 60. Results: we accomplished complete laparoscopic diagnosis in 90% of cases, and avoided negative laparotomy in 5% of cases. We converted about 10% of laparoscopically diagnosed cases to open surgery for therapeutic purposes with significant reduction in complications in laparoscopic cases and mean hospital stay 2.6 days in laparoscopic cases vs. 5.3 days in open cases. Conclusion: laparoscopy was an excellent diagnostic tool. It was a very good therapeutic tool in acute appendicitis, acute cholecystitis and perforated peptic ulcer. It was also safe and satisfactory; also it saved more hospital beds.