Background: Laparoscopic cholecystectomy (LC) is traditionally performed under general anesthesia (GA), which ensures airway protection and optimal surgical conditions. However, GA is associated with notable drawbacks including hemodynamic fluctuations, delayed recovery, and increased postoperative discomfort. Thoracic segmental spinal anesthesia (TSSA) has emerged as a potential alternative, offering improved intraoperative stability and postoperative outcomes. Objective: To compare the intraoperative hemodynamic responses, perioperative complications, postoperative pain, and recovery profile between thoracic segmental spinal anesthesia and general anesthesia in patients undergoing elective laparoscopic cholecystectomy. Materials And Methods: This prospective, comparative observational study was conducted in the Ad-Din Akij Medical College Hospital, Khulna, during over 18 months from January’2023 to June 2024 and included 90 ASA I–II patients aged 25–55 years undergoing elective LC. Patients were randomized into two equal groups: Group a (TSSA) received 1.75 ml of 0.5% isobaric levobupivacaine with 25 µg fentanyl intrathecally at T9–T10; Group B (GA) received standard general anesthesia. Intraoperative heart rate and mean arterial pressure (MAP) were recorded at regular intervals. Postoperative outcomes included VAS pain scores, time to first analgesic, time to ambulation, and incidence of complications. Results: Baseline demographics were comparable between groups. Group A demonstrated significantly lower intraoperative heart rates and higher MAP values from 5 minutes after incision to the end of surgery (p<0.01). Postoperative VAS scores were significantly lower in Group A at 1, 3, and 6 hours (p<0.05). Time to first analgesic was longer (3.4±1.1 vs. 2.2±0.9 hours) and time to ambulation shorter (3.3±1.0 vs. 5.1±1.4 hours) in Group A (p=0.001). Perioperative complications were similar and not statistically significant between groups. Conclusion: TSSA is a safe and effective alternative to GA for laparoscopic cholecystectomy, offering superior intraoperative hemodynamic stability, better early postoperative analgesia, and faster recovery without increasing perioperative complications.