Background: acute cholecystitis is the most common cause of hospitalization for gastrointestinal disease. Although cholecystectomy is the definitive management, the timing of surgery in relation to the first episode of acute cholecystitis remains an area of considerable practice variation. Objective: The aim of this study was to evaluate the results of early laparoscopic cholecystectomy versus conservative management and delayed elective cholecystectomy in acute calcular cholecystitis. Patients and Methods: the present study is a prospective randomized study done during the period from November 2018 to June 2019. The study included 40 patients with acute calcular cholecystitis presented to Al-Azhar University Surgical department. They had been classified randomly by taking every two patients; one patient to the group A, the other patient to group B, and each group consisted of 20 patients. Results: the mean operative time in the early group was more than the mean operative time in the delayed group. The conversion rate to open cholecystectomy in the early group was less than the conversion rate in the delayed group. The mean total hospital stay in the early group was less than the mean total hospital stay in the delayed group. Finally the overall complications in the early group were less than complications occurred in the delayed group. Conclusion: early laparoscopic cholecystectomy for patients with acute cholecystitis has both medical and socioeconomic benefits and it is the preferred approach in comparison to delayed approach.