BACKGROUND This study examines the outcomes of patients who underwent elective sigmoid resection for diverticular disease during the transition period from open to laparoscopic surgery. METHODS The medical records of patients who underwent elective sigmoid resection from July 1, 1993 to June 30, 2005 at a community-based teaching hospital were retrospectively reviewed. Data collected included age, sex, duration of surgery, estimated blood loss (EBL), postoperative day of diet, length of stay (LOS), postoperative complication rate, and readmission rate. Data were compared using Wilcoxon rank sum and chi-square tests. Recurrence rates were evaluated. RESULTS The medical records of 246 patients who had elective sigmoid resections were reviewed. One hundred sixty-six of the procedures were planned open operations, and 80 were initiated with laparoscopy. Of these 80 procedures, 10 were converted to open surgery. Overall, laparoscopic surgery was associated with shorter LOS (median: 4 days versus 8 days, P < 0.001; mean: 4.8 days versus 9.3 days), less EBL (median: 100 cc versus 200 cc, P < 0.001; mean: 167 cc versus 255 cc), and longer operative time (median: 185 minutes versus 153 minutes, P < 0.001; mean: 201.4 minutes versus 157.1 minutes). No mortalities occurred in either group. Readmission and recurrence rates were similar in the open and laparoscopic groups. Subset analyses to adjust for changes in practices over time did not account for improved LOS, EBL, or recurrence rate. CONCLUSIONS Compared with open surgery, laparoscopic surgery for elective sigmoid resection is associated with a significantly shorter hospitalization and similar safety and recurrence rates.