The initial 300 patients whose symptomatic cholelithiasis was managed by laparoscopic cholecystectomy (LC) were matched to and compared with 300 patients managed by open cholecystectomy (OC) during the 30 months prior to the introduction of LC. Of the 300 LC attempted 292 (97.3%) were successful with conversion to OC rate of 2.7%. Besides the obviously better cosmetic results, LC patients had less post operative pain, mean doses of opiates needed 0.01 versus 5 for OC (p < 0.0001), were discharged earlier from the hospital, mean 3.1 days versus 8 days for OC (p < 0.001) and had less postoperative complications 4% versus 11% for OC. We conclude that not only is LC a better operation than OC, but also that in the regional referral centres such as ours, LC can safely supplant OC as the preferred modality for the management of symptomatic cholelithiasis.