Objective: To compare the safety and efficacy of laparoscopic total colectomy and open resection in treatment of familial adenomatous polyposis (FAP). Methods: The clinical data of 56 patients with FAP admitted from January 2003 to January 2011 were retrospectively analyzed. Patients were divided, according to the procedures, into laparoscopic group (31 cases) and conventional open surgery group (25 cases). The pre-, intra- and postoperative data between the two groups were compared. Results: The general data between the two groups before surgery were comparable (P>0.05). There was no significant difference in intraoperative blood loss between the two groups, and no transfusion was required in any of the groups (both P>0.05). However, laparoscopic procedure took a longer operative time than that in open surgery group (P<0.05). In comparison with open surgery group after operation, the incidence of postoperative complications (0 vs. 24%), number of patients needing analgesics (0 vs. 6), average length of postoperative hospital stay (8 d vs. 14 d), and average daily volume of abdominal drainage (30 mL vs. 100 mL) were all significantly reduced in laparoscopic group (all P<0.05), but there was no difference in time to recovery of gastrointestinal function (P>0.05). At three months after operation, no recurrence was noted in laparoscopic group but it occurred in 3 cases in open surgery group (P<0.05). Conclusion: Laparoscopic total colectomy is safe and effective for treatment of FAP, and it is superior to open surgery in improving patients' quality of life and long term outcomes.