PURPOSE: The purpose of this study was to compare the clinical outcomes between laparoscopic (LS) and conventional open splenectomies (OS) in benign splenic diseases. METHODS: We retrospectively reviewed the medical records of patients who had undergone a splenectomy between June 1991 and April 2004. The patients' demographics and operative outcomes were also evaluated. RESULTS: Fifty-four patients were identified; LS and OS were performed in 41 and 13 patients, respectively. The age, gender and operative times between the two groups were similar. The time to resumption of oral intake was faster in the LS patients (2.0 +/- 0.9 vs. 4.0 +/- 5.1 days; P<0.0001). The length of hospital stay was shorter in the LS patients (4.0 +/- 2.4 vs. 12.0 +/- 7.4 days; P<0.0001). There were also significantly lower perioperative complications in the LS compared to the OS patients (4.8 vs. 38.5%; P=0.0017). In the patients with idiopathic thrombocytopenic purpura (ITP), there were no differences in the detection rate of an accessory spleens and the treatment response between the two groups. CONCLUSION: This study shows that LS is a safer than OS, and is an excellent surgical method: earlier diet tolerance, shorter hospital stay and fewer perioperative complications, with good cosmesis. Also, there was no difference in the surgical responses to treatment between the two procedures. Therefore, LS can become the gold standard for the treatment of benign diseases of the spleen.