Purpose Access to laparoscopic cholecystectomy is more limited for remote communities and Indigenous patients internationally. To date, studies exploring the incidence of gallstone disease and access to LC in Australian regional communities are limited. This study examined the rates and outcomes of emergency laparoscopic cholecystectomy (EMLC) in Far North Queensland (FNQ), specifically in Indigenous and remote populations. Methodology We retrospectively examined all patients who underwent an EMLC at Cairns Hospital between 2016-2021. Results Over the study period, 634 EMLCs were undertaken. The average annual rate of EMLC was 56 cases per 100,000. However, rates of EMLC were significantly higher in remote communities and Indigenous patients compared to the remaining cohort. Indigenous and remote patients also had a longer hospital length of stay and more comorbidities. Patients from remote communities were more likely to have pre-existing gallstone disease but were less likely to have been seen in a surgical outpatient clinic prior to admission. Despite this, surgical outcomes for EMLC were comparable to national and international standards. Conclusion This study highlights the challenges in surgical healthcare provision for gallstone disease in a regional centre. The requirement for EMLC disproportionately effects geographically isolated communities and Australian Indigenous people. Addressing the healthcare barriers to management of GD in regional Australia should be a priority.