Aim and background: Pancreatic pseudocysts (PPs) commonly occur as a complication of both acute and chronic pancreatitis. Surgical drainage is indicated when cysts are >6 cm, persist for more than 6 weeks, or cause symptoms or complications. This study aimed to assess and compare the outcomes of laparoscopic and open cystogastrostomy for PPs. Materials and methods: A retrospective comparative study was conducted in the Department of General Surgery at a tertiary care hospital, including 64 patients diagnosed with PPs. Among them, 22 patients underwent laparoscopic and 42 patients underwent open cystogastrostomy procedures. Parameters such as operative time, pain score, blood loss, oral intake, drain duration, complications, hospital stay, and recurrence were assessed. A p-value < 0.05 was considered significant. Results: Mean age was 35.86 +/- 13.49 years in the laparoscopic group and 41.79 +/- 11.64 years in the open group ( p = 0.34). The mean operative time was higher in the laparoscopic group (187.23 +/- 18.80 vs 159.67 +/- 29.88 min, p < 0.0001), whereas the mean blood loss was significantly lower (81.82 +/- 36.34 vs 200.24 +/- 119.56 mL, p < 0.0001). The visual analog scale (VAS) score was lower in the laparoscopic group ( p < 0.0001). Oral feeding started earlier (3.48 +/- 0.93 vs 5.49 +/- 0.68 days), drains were removed sooner (4.48 +/- 1.40 vs 7.17 +/- 1.00 days), and hospital stay was shorter (5.77 +/- 1.60 vs 9.69 +/- 1.57 days) in the laparoscopic group (all p < 0.0001). Mortality was 4.5 and 2.4%, respectively ( p = 0.636). Residual cysts occurred in 4.5 and 4.8% of patients, with no recurrence in either group. Conclusion: Laparoscopic cystogastrostomy demonstrated superior short-term outcomes, reduced blood loss, less pain, earlier recovery, and shorter hospitalization than open surgery, with equivalent safety and recurrence rates.