Background With advancements in skills and technology, colorectal emergencies like malignant obstruction can now be successfully treated with the laparoscopic approach. The aim of this study was to compare the clinical outcomes of emergency laparoscopic versus open right hemicolectomy for obstructing right-sided colonic carcinoma. Methods Between July 2003 and August 2005, 29 consecutive patients with obstructing right-sided colonic carcinoma underwent emergency right hemicolectomy at our institution, 10 with the laparoscopic approach and 19 with the open approach. The demographic data, operative details, and clinical outcomes were prospectively recorded and compared between the two groups. Results There were no significant differences between the two groups with respect to age, genders, comorbidities, tumour length, and tumour staging. The operative time was also not significantly different between the two groups, but the median blood loss was significantly lower in the laparoscopic group (20 ml vs. 100 ml, P = 0.026). The laparoscopic group required significantly shorter median duration of parenteral analgesia (1.5 days vs. 4 days, P = 0.016) and the median time to full ambulation was significantly shorter (4 days vs. 7 days, P = 0.013). However, the time to return of gastrointestinal function and the duration of hospital stay were similar between the two groups. More patients in the open group developed postoperative complications (42.1% vs. 10%), but the difference was not statistically significant. The two groups were also not different in postoperative mortality. Oncological results, in terms of number of lymph nodes removed, recurrence rates, and survival rates were similar in the two groups. Conclusion Emergency laparoscopic right hemicolectomy for obstructing right-sided colonic carcinoma is feasible and safe. Comparing with the open approach, the laparoscopic approach is associated with less blood loss, less analgesic requirement, earlier ambulation, and possibly lower morbidity, without jeopardizing the oncological results.