Background <p>Data on outcomes of ambulatory surgery in Thailand remain limited. Laparoscopic cholecystectomy is the first procedure included in Thailand’s national policy for ambulatory surgery requiring more than local anesthesia or intravenous sedation. This study aimed to compare outcomes of ambulatory versus conventional inpatient laparoscopic cholecystectomy in a regional hospital lacking dedicated ambulatory surgery infrastructure.</p> Methods <p>This retrospective observational cohort study included patients who underwent laparoscopic cholecystectomy between May 2022 and June 2024. Data were obtained from the hospital’s ambulatory surgery registry and electronic medical records. The hospital did not have an established ambulatory unit, and ambulatory laparoscopic cholecystectomy had been implemented less than one year prior to the study period. Treatment allocation (ambulatory vs. inpatient) was determined by the attending surgeons and patient preference. To reduce bias, 1:1 nearest-neighbor propensity score matching was performed based on age, sex, American Society of Anesthesiologists class III status, obesity, and complicated gallstone disease. The primary outcomes were readmission and postoperative morbidity or mortality.</p> Results <p>A total of 570 eligible patients were included. After matching, 358 patients (179 per group) remained for analysis. Readmission and complication rates were comparable between groups, with no observed mortality. Risk ratios (95% confidence intervals) for readmission and complications were 2.00 (0.51, 7.89) and 0.67 (0.19, 2.32), respectively. Although the ambulatory group showed a slightly higher readmission rate, length of hospital stay was significantly shorter by approximately two days.</p> Conclusions <p>In the early implementation phase, among predominantly healthy patients, ambulatory laparoscopic cholecystectomy appeared safe and feasible in a resource-limited setting, with comparable morbidity and a non-significant increase in readmissions—likely attributable to the learning curve and limited patient familiarity with the ambulatory pathway.</p> Trial registration <p>Not applicable as this study is a retrospective cohort study and not a clinical trial.</p>