Background: Laparoscopic cholecystectomy (LC) has largely replaced open cholecystectomy (OC) as the standard surgical treatment for symptomatic gallstone disease. However, there is ongoing debate regarding the differences in postoperative complications and recovery outcomes between these two approaches. Objective: To compare the postoperative complications and recovery outcomes between LC and OC in patients with symptomatic gallstone disease. Methods: This prospective, randomized study included 120 patients with symptomatic gallstone disease who were allocated to either the LC (n=60) or OC (n=60) group. Intraoperative outcomes, postoperative complications, pain scores, recovery measures, and quality of life scores (SF-36) were assessed. Results: LC was associated with significantly shorter operative time (62.5 ± 15.6 min vs. 78.3 ± 18.2 min, p<0.001), lower blood loss (20 mL vs. 40 mL, p<0.001), and a lower incidence of wound infection (3.3% vs. 13.3%, p=0.048) compared to OC. Patients in the LC group had significantly lower postoperative pain scores (p<0.001), shorter hospital stay (median: 2 days vs. 4 days, p<0.001), and earlier return to normal activities (median: 10 days vs. 18 days, p<0.001). Quality of life scores were significantly higher in the LC group at 1 and 3 months (p<0.05). The surgical approach was a significant predictor of postoperative complications (OR: 3.12, 95% CI: 1.02- 9.58, p=0.047) and prolonged hospital stay (OR: 5.04, 95% CI: 1.96-12.95, p=0.001), favoring LC over OC. Conclusion: LC is associated with better intraoperative outcomes, fewer postoperative complications, faster recovery, and improved quality of life compared to OC in patients with symptomatic gallstone disease. These findings support the current recommendations favoring LC as the gold standard for the surgical management of gallstone disease