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Background: Although restorative proctocolectomy (RP) is increasingly being performed via a laparoscopic approach for the treatment of ulcerative colitis and familial adenomatous polyposis, data on costs associated with the technique are lacking. We analyzed the costs of laparoscopic RP (LRP) compared to a matched group of patients undergoing open RP (ORP) and determined whether the increased operative costs are offset by a decreased length of stay (LOS) for the primary procedure and hospitalization within ninety days.Materials and Methods: Patients undergoing LRP were identified from a prospective pelvic pouch database and matched 1:1 by age within 10 years, gender, diagnosis, ASA score, colectomy type (total proctocolectomy and ileo-anal pouch versus completion proctectomy and ileo-anal pouch) and year of surgery with patients undergoing an open pouch procedure. Patient demographics, operative time, LOS, post-operative morbidity and readmission within 90 days were assessed. Direct costs for the operating room, nursing care, intensive care unit (ICU), anesthesia, laboratory, pharmacy, and radiology related to the initial hospitalization and readmissions were compared. Results: 103 patients who underwent LRP from 2003-2009 were identified and matched to patients who underwent ORP. The two groups had similar age, gender, pre-operative diagnosis and ASA score. In each group, 33 (32%) patients had completion proctectomy and ileo-anal pouch and 70 (68%) patients had total proctocolectomy and ileo-anal pouch. LRP had significantly shorter LOS than ORP (median: 5 (IQR 4-8) and 7 (IQR 5-9) days, p<0.001). Although operating room costs (p<0.001), anesthesia costs (p<0.001), professional costs (p=0.004) and global hospital costs (p<0.001) were significantly higher in the laparoscopic group for the primary procedure; nursing, ICU, pharmacy and radiology costs were similar. For hospitalizations within ninety days, there was no difference in the rate of admissions (p=0.86) or hospital costs between the two groups. Analysis of surgical cost for the primary procedure combined with cost for hospitalizations within ninety days for the two groups revealed operating room costs(p<0.001), anesthesia costs(p<0.001), professional costs(p=0.012) and global costs (p<0.001) were significantly higher for the LRP group.Conclusions: LRP is significantly more costly when compared to ORP. The shorter LOS for LRP did not offset the global cost for the primary procedure and hospitalizations within ninety days. Identification of specific scenarios where the clinical benefits of LRP are unequivocal may help improve utilization of resources in the current era of cost containment.