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AIM: This study aims to verify if the duration of postoperative ileus (POI), in patients undergoing abdominal surgery, is related to the surgical approach used (open or laparoscopic) or rather to the manipulation of bowel loops. MATERIALS AND METHODS: Ninety patients, undergoing elective colon resection for cancer, were randomized in three groups with different surgical approaches: open technique with extensive manipulation of intestinal loops (GROUP A), open technique with minimal manipulation (GROUP B) and laparoscopic technique (GROUP C). Return of bowel functions was investigated by: detection of bowel sounds, passage of flatus and passage of stool. RESULTS: Detection of bowel sounds occurred after 2.18 days in GROUP A, after 1.35 days in GROUP B and after 1.19 days in GROUP C. Return of flatus occurred after 3.51 days in Group A, after 2.53 days in GROUP B and after 2.30 days in GROUP C. Passage of stool occurred after 4.48 days in GROUP A, after 3.75 days in GROUP B and after 3.61 days in GROUP C. In all end-points analyzed, differences between GROUP A and GROUP B and between GROUP A and GROUP C are significant (P< 0.01) whereas the differences between GROUP B and GROUP C are not significant (P > 0.01). CONCLUSIONS: In colon surgery open technique with minimal manipulation of loops obtains similar results in those of the laparoscopic technique, in terms of resolution of postoperative ileus.