Background Cholecystectomy remains one of the most frequently performed abdominal surgeries worldwide. The introduction of laparoscopic cholecystectomy (LC) has revolutionized biliary surgery, offering reduced postoperative morbidity and faster recovery compared with the traditional open approach. However, outcome variations across different healthcare systems—particularly in transitional economies such as Georgia—necessitate continued comparative evaluation. Objective To compare postoperative outcomes between laparoscopic and open cholecystectomy (OC) in patients with symptomatic gallstone disease at a tertiary teaching hospital in Georgia. Methods This prospective comparative study was conducted at Tbilisi State University Hospital between January 2023 and December 2024, enrolling 200 patients with symptomatic cholelithiasis who underwent elective cholecystectomy—100 laparoscopic and 100 open. Exclusion criteria included acute cholecystitis, choledocholithiasis, and previous upper abdominal surgery. Standardized perioperative and postoperative care protocols were applied. Data were analyzed using SPSS v26.0. Continuous variables were compared using the independent t test and categorical data with the Chi-square test; P < 0.05 was considered statistically significant. Results Baseline demographics were comparable between the two groups. The mean operative time was slightly longer for LC (62.3 ± 14.5 min) than OC (56.8 ± 11.7 min; P = 0.067). LC patients experienced significantly less postoperative pain (VAS 24h: 2.4 ± 0.9 vs. 5.2 ± 1.1; P < 0.001) and fewer wound infections (2% vs. 9%; P = 0.028). Mean hospital stay was markedly shorter in the LC group (1.8 ± 0.7 days) compared to the OC group (5.4 ± 1.2 days; P < 0.001). Patients resumed normal activity earlier following LC (6.2 ± 2.1 days vs. 13.8 ± 3.3 days; P < 0.001). Multivariate regression identified open surgery, ASA ≥ III, and age >50 years as independent predictors of postoperative complications (P < 0.05). No mortality or major bile duct injury occurred. Conclusion Laparoscopic cholecystectomy provides superior postoperative outcomes compared with the open technique, including significantly lower pain intensity, fewer wound infections, shorter hospitalization, and faster recovery. These findings validate LC as the gold standard for elective gallbladder surgery and support its broader adoption across Georgian and regional healthcare systems. Expansion of laparoscopic infrastructure, standardized training, and national clinical guidelines are recommended to ensure safe, equitable access to minimally invasive surgery.