BACKGROUND Laparoscopic splenectomy has become a standard treatment of various haematological disorders, but its feasibility in the setting of β thalassemia has not been established. METHODS Fifty patients of β thalassemia underwent laparoscopic splenectomy between January 2006 and December 2008. "Anterior approach" method was practiced in all cases, with early ligation of splenic artery and delayed ligation of splenic vein. Specimen was extracted piecemeal via the umbilical port in initial 12 cases, while in 37 cases the specimen was extracted through a 7-8-cm pfannenstiel incision. Twelve patients of β thalassemia having grade IV splenomegaly with hepatomegaly were electively operated by conventional open method. RESULTS The procedure was completed in 49 patients. One (2%) patient required conversion to open surgery. Mean operating time in the first 12 cases was 151 minutes (110-210 minutes), while in 37 cases of splenectomy completed laparoscopically it was 124 minutes (80-190 minutes) [P < 0.05]. Mean intra-operative blood loss was 73.8 ml (30-520 ml). No major intra-operative complications occurred. No patient required per-operative blood transfusion. Mean postoperative hospital stay was 4.7 days (2-11 days). Mean preoperative blood transfusion requirement was 11.98 units per patient per year, while mean postoperative blood transfusion requirement was 4.04 units [P< 0.05]. CONCLUSIONS Laparoscopic splenectomy is feasible and safe even in patients of β thalassemia with massive splenomegaly. Removal of specimen via a pfannenstiel incision significantly saves time, carries low morbidity and is a cosmetically acceptable alternative.