A laparoscopic approach to ileoanal pouch formation is novel. By using prospectively gathered data, laparoscopic and open restorative proctocolectomy procedures in mucosal ulcerative colitis (UC) and familial adenomatous polyposis (FAP) patients were compared using a case-matched design.Ten consecutive patients have had laparoscopic ileal pouch anal anastomosis (IPAA) since April 2005. Their intraoperative findings, immediate and early postoperative outcomes are compared with ten non-selected patients who had an open IPAA pre April 2005.Laparoscopic IPAA group had a shorter time to ileostomy function, a reduced mean time to regular diet and a mean shorter hospital stay. Their overall opioid analgesia requirements were 50% that of the open group. There were no re-operations or readmissions in either group. Mean operative time was longer for the laparoscopic group.Patients undergoing laparoscopic IPAA can expect faster postoperative gastrointestinal recovery, reduced blood loss, reduced opioid requirements and improved cosmesis.