Objective To explore the efficacy of laparoscopic cholecystectomy for acute calculous cholecystitis. Methods A total of 80 patients with acute calculous cholecystitis were selected from January 2023 to July 2025. Based on the surgical approach, the patients were divided into a control group （undergoing open cholecystectomy） and a study group （undergoing laparoscopic cholecystectomy）, with 40 cases in each group. Clinical indicators （operation time, intraoperative blood loss, postoperative anal exhaust time, time of first ambulation, and length of hospital stay）, stress response indicators [tumor necrosis factor α （TNF-α）, interleukin 6 （IL-6）, and C-reactive protein （CRP）], postoperative pain levels, and complication rates were compared between the two groups. Results The study group showed shorter operation time, postoperative anal exhaust time, time of first ambulation, and length of hospital stay, as well as less intraoperative blood loss than the control group. （P<0.05）. The study group also demonstrated lower levels of TNF-α, IL-6, and CRP after operation, as well as lower pain scores at different time points （4, 6, 24 h after surgery） than the control group （P<0.05）. The complication incidence rate in the study group was significantly lower than that in the control group （P<0.05）. Conclusion Laparoscopic cholecystectomy can reduce trauma to patients, with advantages such as milder pain and stress responses, lower postoperative complication rates, and faster recovery. It holds clinical significance for treating acute calculous cholecystitis.