Hand-assisted laparoscopic surgery (HALS) leads to fewer complications than converting laparoscopic procedures to open surgery (LCOS) in proctectomy patients.

• Patients undergoing LCOS had a 20.85% transfusion rate vs. 5.99% for HALS (p < 0.001).
• Postoperative renal insufficiency occurred in 17.06% of LCOS patients vs. 7.12% of HALS patients (p < 0.001).

Considering HALS in complex cases may improve outcomes and avoid unnecessary conversions.

• Mortality was 1.90% in the LCOS group compared to 0.37% in the HALS group (p = 0.018).