OBJECTIVES: To compare the results, complications, and hospital charges associated with laparoscopy versus laparotomy in second-look operations for epithelial ovarian cancer. METHODS: We conducted a retrospective chart review of 109 patients with invasive epithelial ovarian cancer who underwent a second-look operation between July 1, 1992, and June 30, 1995. RESULTS: Thirty-one patients (28.4%) underwent laparoscopy, 70 patients (64.2%) underwent laparotomy, and eight patients (7.3%) underwent both procedures at the same operation. The majority of patients (60.6%) presented with stage IIIC disease. Persistent ovarian cancer was found in 65 of 109 (59.6%) patients, including 17 of 31 (54.8%) evaluated by laparoscopy, 43 of 70 (61.4%) by laparotomy, and five of eight (62.5%) by both procedures. Significantly lower mean blood loss was noted in patients undergoing laparoscopy (27 mL) compared with laparotomy (208 mL) (P < .01). In addition, the mean operating time for laparoscopy (129 minutes) was significantly shorter than that for laparotomy (153 minutes) (P < .01), and mean hospital stay was shorter for patients undergoing laparoscopy (1.6 days) compared with laparotomy (6.8 days) (P < .01). All intraoperative and immediate postoperative complications were noted in patients who underwent laparotomy. There was no difference in day of surgery charges between the two procedures; however, total hospital charges were significantly lower for patients undergoing laparoscopy ($ 9448) compared with laparotomy ($ 17,969) (P < .01). With a median follow-up of 22.0 months, recurrence after negative second-look surgery was noted in four of 27 (14.8%) patients evaluated by laparotomy and two of 14 (14.3%) patients evaluated by laparoscopy. CONCLUSION: Laparoscopy may be an acceptable alternative to second-look laparotomy for interval evaluation of epithelial ovarian cancer. Second-look laparoscopy probably results in less morbidity, shorter operating time, shorter hospital stay, and lower total hospital charges. These results require confirmation in a randomized clinical trial.