Chagas disease (American trypanosomiasis) is the most common cause of megacolon in adults in Brazil. Surgical treatment is indicated when complications occur or when quality of life remains severely compromised. Adequate surgical treatment requires resection of a largely dilated left colon and construction of a low colorectal anastomosis. Improvements in laparoscopic techniques enabled most colorectal procedures, even the most challenging one, to be performed using a video approach. This study was designed to compare the outcomes of laparoscopic anterior resection with low colorectal anastomosis with the open approach for treatment of acquired (chagasic) megacolon.A total of 22 patients who underwent laparoscopic (LAP) anterior resection for chagasic megacolon were compared to 22 patients submitted to open (OPEN) operation at the same time interval and at one institution. There were no differences between the groups regarding age, sex and previous abdominal operation. Operation time was longer in the LAP group (278 vs. 231 min; P=0.031) but the blood loss was less (210 vs. 260 ml; P=0.027). There was no difference regarding specimen length (29.8 vs. 30.9 cm; P = 0.775). There was no mortality. There were no intraoperative complications neither need for conversion. Length of stay was reduced for LAP group (10.5 vs. 12.7 days) but not significantly (P=0.173). There was no difference in postoperative morbidity between the groups. Anastomotic leakage occurred in two patients after LAP and in 3 patients after OPEN. Only one patient at the LAP group needed a reoperation. Four patients in the OPEN group were reoperated due to infectious complications.A laparoscopic approach for the treatment of acquired megacolon through colon resection and low colorectal anastomosis is feasible and represents a safe option with short-term advantages when compared to the open approach.