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Background: Single incision laparoscopic cholecystectomy (SILC) has fallen into favor by some surgeons as a way of improving patient satisfaction for cosmesis. Multiple reports have been published describing the feasibility and safety of this approach. However, few reports have compared SILC to conventional laparoscopic cholecystectomy (LC). We set out to compare our experience with both approaches from the years of 2008-2010.Methods: Twenty one SILC were performed in the period of 10/2008 and 10/2010. We retrospectively compared our experience to 100 conventional LC over a similar time period performed at the same institution. Variables compared include: BMI, age, pre-operative diagnosis, operative time, and hospital charges. Results: Five of the 21 (23.8%) attempted SILC procedures had to be converted to traditional LC for various reasons pertaining to safe identification of anatomy. SILC patients were overall younger with a mean age 35.6 (18-65) compared to 45.9 (18-80) for the LC group (P 0.0062). The average BMI in the SILC group was 25.8 (18-33) compared to 32.3 (16.4-65.5) in the LC group (P 0.0024). Operative time in the SILC group was significantly longer with an average of 97 minutes compared to LC that averaged 53 minutes (P <0.001). Hospital charges for the two techniques were not statistically different and averaged $20,128 (9782-58,205) in SILC patients versus $20,751 (11,449-86,417) in LC patients (P 0.8846). Finally, in SILC patients, pre-operative diagnosis favored biliary colic (60%) and biliary dyskinesia (40%). In LC patients, the pre-operative diagnosis also favored biliary colic (54%); however, a larger percentage of patients had acute cholecystitis (25%).Conclusions: Single incision laparoscopic cholecystectomy is favored in younger patients with a lower BMI and non-acute pathology but the operative time is significantly longer. However, our data suggests that even though operative time is longer in the single incision laparoscopic cholecystectomy, hospital charges are comparable to conventional laparoscopic cholecystectomy. In terms of cost analysis, SILC is a justifiable option in a carefully selected group of patients, although it does subject patients to longer anesthesia time.