A total of 686 consecutive cases were reviewed for comparison between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC). The procedures were performed by the teaching surgical service of a community hospital. Between March 1989 and December 1992, 381 patients had LC, 262 had OC, and 43 patients had attempted LC that was converted to open cholecystectomy (CONV). Postoperative hospital stay for LC was 2.9 +/- 3.7 days (range 12 h to 28 days) and was significantly less than those for OC (12.4 +/- 23.6 days) or CONV (8 +/- 8.3 days) (p < 0.0001). Patients who had LC revealed meaningfully decreased perioperative or postoperative antibiotic use, postoperative temperature elevations, and hospitalization when compared to OC or CONV (p < 0.0001). Bile duct injury was 0.26% with LC and 0.38% with OC. The percentage of postoperative bile leakage was 0.79% and 0.38% for LC and OC, respectively. LC cases were associated with lower complication rates when compared to OC or CONV (p < 0.005). No deaths were observed with LC (0%). However, the mortality rate for OC was 1.5%. The results of LC were more favorable than those of OC and CONV with respect to complications, morbidity, mortality, and length of hospital stay. Based on our experience, the patient outcome for LC was superior to OC.