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In parallel with the laparoscopic development, enhanced recovery after surgery (ERAS)programs are shown to improve postoperative recovery in open colo-rectal surgery. This study reports adherence to the ERAS-protocol and outcomes in laparoscopic and open surgery.The association between surgical approach, compliance to the ERAS-protocol, postoperative symptoms, complications and length of stay following surgery was studied. Between January 2007-December 2009, ninety-six consecutive patients underwent high anterior resection with laparoscopic-assisted (n = 49) or open resection (n = 47). All clinical data, (114 variables) wereprospectively recorded.The overallpreoperative ERAS-protocol compliance was 82.7% in the laparoscopic group compared to 86.8% in the open group (P < 0.155). There was no significant difference in postoperative complications 10.2% vs 14.9%, OR 0.69 (95% CI 0.16-3.02), overall postoperative symptoms delaying recovery 22.4% vs 27.7%, OR 0.63 (95% CI 0.22-1.79) or median hospital stay (4 vs 5 days) in patients undergoing laparoscopic vs. open resection. Theproportion of patients within target length of stay £3 was larger in the laparoscopic group, 13 (26.5%) vs 5 (10.6) OR = 0.29 (95% CI 0.09-0.96).An ERAS setting facilitates the evaluation of laparoscopic colorectal surgery byproviding close audit and a firm framework for the perioperativeprocess.