Twenty-nine consecutive laparoscopic cholecystectomies (LC) performed between April 1992 and December 1993 were compared with 23 consecutive open cholecystectomies (OC) performed between January 1991 and March 1992 with regard to clinical, surgical, and economic factors. Most patients were Caucasian (> 70%), and symptomatic nonhemolytic cholelithiasis was the most common indication for cholecystectomy. The introduction of LC did not significantly increase the number of cholecystectomies performed per annum. There is a learning curve to LC: the average length of operative time required during the first year was significantly longer than that of OC and the average time for LC during the second year (P < .01). By the second year, the average operative time of LC was not significantly different from OC. There was no conversion from LC to OC, and the complication rate was minor in both groups. The postoperative parenteral analgesic requirement for LC was significantly less than OC (P < .01). The mean length of hospitalization of LC was about three times shorter than that of OC (P < .01). Although the average operating cost per case of LC was significantly more expensive than OC, LC was significantly cheaper because the period of hospitalization was significantly shortened (P < .01). In conclusion, LC is the procedure of choice in the treatment of symptomatic cholelithiasis in children.