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Background: Cholecystectomy remains the definitive treatment for complicated gallbladder disease, with laparoscopic (LC) and open cholecystectomy (OC) as primary surgical approaches. Objective: To compare recovery trajectories and complication rates between laparoscopic and open cholecystectomy in patients with complicated gallbladder disease. Method: A randomized controlled trial was conducted at Veer Surendra Sai Institute of Medical Sciences And Research (VIMSAR), Sambalpur, Odisha, from 2021 to 2024. A total of 300 patients diagnosed with complicated gallbladder disease were randomly assigned to undergo either LC (n=150) or OC (n=150). Recovery metrics, including time to ambulation, length of hospital stay, and return to normal activities, were assessed. Complication rates, such as bile duct injury, infection, and hemorrhage, were recorded. Statistical analyses involved chi-square tests for categorical variables and t-tests for continuous variables, with significance set at p<0.05. Additionally, multivariate regression was utilized to adjust for potential confounders, and cost-effectiveness was evaluated based on hospital expenses and patient recovery times. Result: Among the 300 patients, the LC group exhibited a significantly shorter hospital stay (mean 3.2 days vs. 6.8 days, p<0.001) and faster ambulation (mean 12 hours vs. 24 hours, p<0.001) compared to the OC group. Return to normal activities was expedited in the LC group (mean 7 days) versus the OC group (mean 14 days, p<0.001). Complication rates were markedly lower in LC (15%) compared to OC (30%, p=0.002). Specifically, bile duct injuries occurred in 2% of LC patients versus 5% of OC patients, infections in 5% versus 12%, and hemorrhages in 3% versus 13%. Multivariate analysis confirmed that LC was independently associated with reduced hospital stay (β=-3.6, p<0.001) and lower overall complications (OR=0.45, 95% CI: 0.28-0.72, p=0.001). Cost analysis revealed that LC incurred an average cost of INR 50,000 compared to INR 70,000 for OC, indicating a 28.5% cost reduction. Additionally, the conversion rate from LC to OC was 10%, primarily due to severe inflammation and anatomical variations. Conclusions: Laparoscopic cholecystectomy significantly enhances recovery times and reduces complication rates compared to open cholecystectomy in patients with complicated gallbladder disease. These findings support the preferential use of LC as the standard surgical approach in such clinical scenarios. [ABSTRACT FROM AUTHOR]