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Background/Aim: Recent reports suggest that laparoscopic as opposed to open cholecystectomy may be better tolerated in cirrhotic patients. We sought to assess the impact of the selection of the surgical approach in cirrhotic patients undergoing cholecystectomy by the use of the Nationwide Inpatient Sample (NIS), the largest population-based and geographically representative all-payer database of hospital discharges in the United States.Methods: All patients with cirrhosis who underwent cholecystectomy (open or laparoscopic) between 2003 and 2006 were queried from the NIS. Associated complications including infection, ascites, transfusion, reoperation, and liver failure were compared amongst the groups. In-hospital mortality was determined.Results: A total of 3242 patients with liver cirrhosis underwent cholecystectomy : 384 patients underwent open cholecystectomy (OC) whereas 2858 patients underwent laparoscopic cholecystectomy (LC), which included 412 patients converted (LCC) from laparoscopic to open cholecystectomy. There was no difference in regard to age, sex, or race. Postoperative infection was higher in those undergoing open (OC) as opposed to those undergoing laparoscopic (LC) or laparoscopic converted to open (LCC) cholecystectomy (3.7% vs 0.7% vs 0.2%, p<0.0001). Ascites was significantly more common in OC as opposed to LC or LCC (18.0% vs 9.4% vs 11.4%, p<0.0001). The need for blood transfusion was significantly higher in the OC and LCC groups as compared to the LC group (19% vs 14% vs 6%, p<0.0001). Furthermore, reoperation occurred more frequently following OC or LCC as opposed to LC (1.6% vs 2.4% vs 0.8%, p<0.008). Liver failure was significantly higher after OC as compared to LC or LCC (7.0% vs 1.4% vs 1.5%, p<0.0001). In-hospital mortality was significantly higher after OC as compared to either LC or LCC (8.4% vs 1.4% vs 1.2%, p<0.0001).Conclusion: Patients with liver cirrhosis have increased in-hospital morbidity and mortality following open as opposed to laparoscopic or conversion to open cholecystectomy. Laparoscopic cholecystectomy should be the preferred initial approach in cirrhotic patients.