Objectives: Laparoscopic cholecystectomy (LC) in acute cholecystitis is challenging especially in the presence of dense inflammatory adhesions and pericholecystic collection. The objective of this study was to evaluate the use of left approach in cases of difficult LC due to acute cholecystitis.   Patients and methods: This was a prospective study done in Badr hospital – Helwan University and in Dar El Shefa hospital – Ministry of Health in Egypt between January 2014 and March 2016 which included 24 patients with difficult LC due to acute cholecystitis. We started the procedure with conventional four ports technique and if failed, we shifted to left approach instead of converting to open surgery. Outcome measures were operative time, rate of conversion to open and intra and post-operative complications.   Results: The mean operative time was 135 minutes and in 1 patient (4%) the procedure was converted to open surgery due to unclear biliary anatomy. There were no intra-operative complications. Two patients (8.3%) in this study had port site infection and 1 patient (4%) had chest infection on the 3rd postoperative day. Postoperative bile leak was not detected in any of our patients.   Conclusion: The use of left approach technique in LC for difficult cases of acute cholecystitis is effective and safe and further studies should be done to include larger number of patients with different types of difficulties.