Background <p>Pancreatoduodenectomy (PD) is a major abdominal surgery. While laparoscopic PD (LPD) is gaining acceptance globally, its feasibility and safety in low-resource settings require further evaluation. This study aimed to identify the benefits and drawbacks of LPD compared to open PD (OPD) in a developing African country.</p> Patients and methods <p>This randomized controlled trial included patients with oncologic indications for PD. Participants were randomized into two groups: LPD and OPD. The primary endpoint was length of hospital stay, postoperative morbidity and mortality, blood loss, and the need for transfusion of blood products. The secondary outcomes were the operative time in minutes, pain VAS scores, duration to ambulation, gastrointestinal (GIT) recovery, and the quality of oncological resection.</p> Results <p>A total of 68 patients were initially screened for eligibility, of whom 48 were randomized and underwent pancreatoduodenectomy (LPD: <i>n</i> = 30; OPD: <i>n</i> = 18). Twenty patients discontinued the intervention after randomization due to withdrawal or peri-induction instability, resulting in a dropout rate of 29.4%. The duration of hospital stay was significantly shorter in the LPD group (8.1 ± 5.6&#xa0;days) than the OPD group (10.6 ± 6.1&#xa0;days, <i>p</i> = 0.049). LPD also demonstrated lower intraoperative blood loss, reduced transfusion rates, faster gastrointestinal recovery, and earlier ambulation. Oncologic outcomes, including margin status and lymph node yield, were comparable between groups.</p> Conclusion <p>LPD resulted in a significantly shorter hospital stay compared to OPD, confirming its benefit in postoperative recovery. Despite a longer operative time, LPD showed advantages in blood loss, transfusion needs, and functional recovery, while maintaining comparable oncologic safety. These findings support the feasibility and potential value of LPD in selected patients, even within a resource-constrained setting.</p>