AIM: To compare hospital outcomes and long-term quality of life (QOL) in patients after open vs. laparoscopic sigmoid colectomy. METHODS: Patients who underwent laparoscopic sigmoid colectomy from 1996 through 2002 at our institution were matched to the same number of control patients after open sigmoid colectomy according to age, sex, indication for operation, and follow-up time. Each group consisted of 38 patients with an median age [range] of 59 years [38-89y] and an overall follow-up of 55 months [8-74 mo]. Indications for operation were recurrent diverticulitis in 26 and cancer in 12 patients in each group. Hospital stay, first bowel movement, duration of operation, and complications were quantitated. A telephone interview followed a standardized questionnaire to determine patients’ general gastrointestinal and overall well-being. Thereafter, the gastrointestinal quality of life index (GIQLI) was sent to patients and controls. 23 of the 38 patients (61%) in each group returned the questionnaire. RESULTS: Long-term QOL, determined by the overall GIQLI, was similar after open and laparoscopic sigmoid colectomy when performed either for recurrent diverticulitis (mean±SEM; 95±9 vs. 95±8; n.s.) or for colonic cancer (106±11 vs. 114±10; n.s.). Overall satisfaction with the operation did not differ between groups and was 100% in the cancer group for both operations. In the diverticulitis group one patient (4%) after the laparoscopic and three patients (12%) after the open operation complained of persistent abdominal pain. Therefore, overall satisfaction was 96% and 88%, respectively. Less patients complained of aesthetically displeasing scars in the laparoscopic group when the operation was performed for diverticulitis (0% vs. 64%; p<0.05), whereas no differences occurred in the colon cancer groups (0% vs. 12%; ns). Postoperative bowel habits at time of follow-up did not differ between groups. Operating time (mean±SEM) was longer in the laparoscopic group (171±8 vs. 128±5 min; p<0.05), while postoperative stay was shorter (7±1 vs.11±1 days; p<0.05). The first postoperative bowel movement (median [range]) occurred earlier after laparoscopic sigmoid colectomy (3 days [2-4d] vs. 3.5 days [2-5d]; p<0.05). No major complications occurred in either group, but minor complications occurred more frequently in the open group (53% vs. 11%; p<0.05). CONCLUSION: The operative approach (laparoscopic vs. open) for recurrent diverticulitis or sigmoid colon cancer has no apparent influence on long-term gastrointestinal QOL. However, the laparoscopic approach offers a better cosmetic result and a lesser incidence of minor postoperative complications.