Background: To review the results of elective laparoscopic anterior resection (LAR) for recurrent and complicated sigmoid diverticulitis, and determine the factors associated with surgical complications. Methods: Data on patients who had had elective surgery for recurrent and complicated sigmoid diverticulitis were extracted from a prospective computerized database. Results: Review of the database revealed 62 consecutive patients who had undergone LAR. These patients were initially compared with 20 patients who had undergone elective open anterior resection (OAR). There were no significant differences between the groups in relation to age, sex, indication for surgery, Hinchey stage of perforation, extent of adhesions or comorbidities. The intraoperative time for LAR was significantly shorter (mean±SEM 110.87±4.8 min vs. OAR 134.35±8.4; p=0.032) and blood loss was less (88±18 ml vs. OAR 134±24 ml; p=0.003). Postoperative passage of flatus occurred earlier after LAR (p<0.003). Hospital stay was shorter after LAR (p<0.001). Complications occurred in nine patients (15%) after LAR and in six patients (30%) after OAR (p=NS). Among the LAR patients the risk of complications was higher in those with preexisting comorbidities (p=0.037). Time to postoperative passage of flatus correlated positively with age (p=0.004). Conclusions: Elective LAR for recurrent and complicated sigmoid diverticulitis could be performed safely and expediently. Bowel function recovered later in older patients. The risk of medical complications was related to preexisting comorbidities. © 2008 Springer-Verlag.