Purpose: Inflammatory Bowel Disease (IBD) patients have a high incidence of wound and overall postoperative complications related to malnutrition, steroid use and disease characteristics. A decreased incidence of wound complications has been reported after laparoscopic surgery. A totally laparoscopic approach should virtually eliminate this risk as well as provide the expected benefits of a minimally invasive approach. Very few studies are available looking at the potential benefits of a totally laparoscopic total proctocolectomy (TL-TPC), using the perineal wound for extraction. We compare our prospectively collected experience with TL-TPC to open TPC during the same study period.Methods: Between August 2002 and September 2008, 30 consecutive IBD patients underwent TL-TPC. These were compared with 29 consecutive IBD patients that underwent open TPC. Patient and disease specific characteristics, perioperative and short-term postoperative outcomes were prospectively collected and analyzed.Results: In the TL-TPC group there were 8 males and 22 females (mean age=52; mean BMI=26.2) while the open TPC patients included 15 males and 14 females (mean age=50; mean BMI=26.5). There was no difference in comorbidities, disease duration, disease activity, previous abdominal surgery, nutritional status and steroids use between groups. Mean operative time was similar between groups (347±71 minutes for TL-TPC and 324±85 minutes for open TPC; p=0.29). A significant difference in favor of TL-TPC was noted for blood loss (276±252ml for TL-TPC and 510±348ml for open TPC; p=0.006) and intraoperative transfusion requirement (0.2 units/case for TL-TPC and 0.4 units/case for open TPC; p=0.42). Return of bowel function measured as an ileostomy output >100ml/8hr occurred at a mean of 2.8±3.4 days for TL-TPC versus 3.2±1.6 days for open TPC (p=0.59). The mean length of stay was 8.5±5.8 days for TL-TPC versus 9.2±3 days for open TPC (p=0.58). The overall complication rate was 33% for TL-TPC versus 52% for open TPC (p=0.15). Postoperative abdominal wound infections occurred in 21% of open TPC patients versus no TL-TPC patients (p=0.007), and a parastomal hernia was diagnosed in 3.3% of TL-TPC patients versus 6.7% of the open TPC patients (p=0.54). Median follow-up was 2 years (TL-TPC) versus 4.8 years (open TPC).Conclusions: The largest yet recorded experience of TL-TPC shows: 1) similar operative time; 2) decreased blood loss and intraoperative transfusion requirements; 3) decreased abdominal wound and parastomal complications. TL-TPC is therefore considered a safe alternative to open surgery for selected IBD patients.