Aim: To analyze outcomes after open small-incision surgery (minilaparotomy) guided by ultrasonography and laparoscopic surgery for gallstone disease. 
Methods: This study was a randomized trial comparing laparoscopic cholecystectomy (LC) to sonar guided minilaparotomy cholecystectomy (SMC) at El-Minia University Hospital and carried out in 60 patients from March 2005 to February 2006. LC was a routine procedure at El-Minia University hospital, whereas SMC was introduced recently. 
Results: Of 60 patients, 30 were randomized to LC and 30 to SMC. The groups were well matched for age and sex. Median operating times were 100 and 48 minutes for LC and SMC, respectively. Median hospital stay was nearly equal in both groups. Intraoperative complications were less frequent in the SMC group, but there was no difference in the postoperative complication rate between the groups. Costs for operation, other health care costs, costs due to sick-leave and total costs were calculated and proved to be significantly higher in LC group. There was no bile duct injury in each group and no deaths. 
Conclusions: Operating time was longer and costs were higher for LC compared with SMC. Further analyses of LC versus 
SMC are necessary regarding surgical training, surgical outcome, and health economy.