Objective: To compare the complications and symptomatic relief of the laparoscopic cholecystectomy (LC) with the small incision cholecystectomy (SIC) in patients with symptomatic Cholelithiasis. Material and Methods: This comparative study was conducted in the Surgical Department of Peshawar Institute of Medical Sciences Hayatabad Peshawar from January 2014 to December 2014 total numbers of 157 patients, aged between 18-60 years, having symptomatic gallstones were enrolled from the Out Patients Department using purposive convenient sampling. Operation, anesthesia, analgesics and postoperative care were standardized and both Laparoscopic cholecystectomy (LC) and small incision cholecystectomy (SIC) were performed by the same group of surgeons. Complications and symptom relief were primary outcome measures, operative time and hospital stay were secondary outcome measures. The patients were followed up on 2 weeks, and 6 weeks postoperatively. Results: Out of 157 patients, 80 underwent SIC and 77 underwent LC. Both groups were matched for age, gender, BMI, clinical findings and ASA grading. The mean duration of operation was 44 and 62 minutes in the SIC and LC groups, respectively (p = 0.000). LC was found to have shorter duration of hospital stay and return to regular activities as compared to SIC. Pain scores were the same in both groups while intra-operative and post-operative complications were slightly greater in LC group as compared to SIC group. Conclusion: SIC is comparable to LC in terms of complication rate and symptomatic relief. It offers a good alternative in areas where LC facility or expertize is not available.