The global population is aging rapidly, and as a result emergency abdominal surgery for acute abdomen in the elderly has become a global issue. Demographic changes in the population have also altered the profile of emergency abdominal surgery, with typical causes of acute abdomen in the elderly including acute cholecystitis, incarcerated hernia, bowel obstruction and appendicitis. In these patients, recovery from surgery is often complicated, leading to longer hospital stays compared with younger patients. Laparoscopy in the emergency setting is well established and offers a number of advantages over open surgical approaches, such as reduced postoperative pain, length of hospital stay and complication rates. While laparoscopic surgery for acute diverticulitis has become more widespread, in other conditions, like small bowel obstruction and perforated peptic ulcer, laparotomy is still used in about 70% of cases. Further, despite the urgent need for knowledge regarding surgical treatment of acute abdomen in the elderly, there is still a lack of evidence in this relevant clinical field.