Introduction & Objective: The first documented laparoscopic cholecystectomy was performed by Erich Mühe in Germany in 1985. In the developed countries, currently over 90% of cholecystectomies are performed laparoscopically. It is generally believed that laparoscopic cholecystectomy has better results than open cholecystectomy in term of patient's compliance and early return to work but it seems that the final outcomes are not different. New studies show that open cholecystectomies with small incision are a good alternative for the selected patients. The aim of this study was to compare the efficacy of laparoscopic and open cholecystectomy in the clinical outcome and patient satisfaction. Materials & Methods: Between January 2005 and August 2006, 150 patients with a diagnosis of symptomatic gallstone, were assigned for cholecystectomy. They were divided in two groups; the first group (n=91) were assigned to open cholecystectomy in Baqiyatallah hospital; the second group (n=59) were assigned to Laparoscopic cholecystectomy in Milad hospital. Then they followed for their symptoms of recovery and satisfaction four month later. Results: After four months follow up there was no differences observed in symptoms of recovery and patient satisfaction (62.6% vs. 62.7) between the two groups. The improvement rate of abdominal pain after laparoscopic and open cholecystectomy seems to be very good and equivalent for 63% of the patients in the two groups, although improvement of symptoms in dyspeptic patients were lower, but it was similar within the both groups. Conclusions: Laparoscopic surgeries are more expensive because of its modern equipments and expensive Instruments. Open cholecystectomy, especially with small incision, is an acceptable alternative for the treatment of symptomatic gallstone disease. It is recommended to have the open cholecystectomies with small incisions for the patients who don’t need to return to work early or for the patients who cannot offer for laparoscopic cholecystectomy.