Background and aims Colonic resection is mandatory in complicated colonic diverticular disease (DD). The impact of video assisted surgery is still unclear. The aim of this study was to evaluate the clinical outcome and quality of life in patients affected by DD submitted to open colonic resection compared to those who had video assisted colonic resection. Patients and methods All the consecutive patients who were admitted in the departments of surgery of Padova (1999-2008) and Arzignano (2004-2008) Hospitals for left iliac pain and endoscopical or radiological diagnosis of diverticular disease, after a minimum follow up of 3 months after hospital discharge, were contacted for an outpatients visit. Fifty-eight accepted to be enrolled: 25 of them were treated with medical therapy while 18 and 15 of them underwent video assisted and open colonic resection, respectively. Disease severity at admission was assessed with Hinchey scale and details about surgical procedures and complications were retrieved. The interview included the Padova Inflammatory Bowel Disease Quality of Life (PIBDQL) and the Cleveland Global Quality of Life (CGQL) questionnaires, the Visual Analogue Scale (VAS) for quality of life, the Body Image Questionnaire, the Bristol Fecal score and an ad hoc symptoms score. Eighty-one healthy subjects were enrolled as control group. Non parametric tests were used.Results Either PIBDQL or CGQL scores were worse in all patients with DD compared to those obtained by healthy subjects (p<0.01). In fact, these scores were significantly worse in patients with DD treated with medical therapy and in those who had open surgery than in healthy subjects (p<0.01). On the contrary CGQL scores were similar in patients who had video assisted surgery compared to controls (Figure 1). PIBDQL scores correlated with the symptoms score (r=0.60, p<0.01). CGQL scores and VAS at follow up correlated with Hinchey disease activity at presentation (r=-0.31, p=0.02). Body Image Questionnaire scores correlated inversely with the presence of a stoma (r=-0.37, p=0.04). Conclusions Our study showed that DD has an important impact on quality of life. Video assisted surgery seems to improve generic quality of life of patients while disease specific quality of life seemed only to depend on current disease activity. The presence of a stoma affected the body image of patients.