Background Laparoscopic drainage of appendicular abscess has become a novel technique due to its advantages over interventional radiology like a complete exploration of the abdomen, exclusion of other pathologies, excision of the appendix at the same session, better cosmesis, decreased incidence of wound infection, better visualization of surgical field, fine handling of edematous tissue and drainage of multiple collections. Patients and methods This randomized controlled clinical trial included all patients who developed the manifestations of appendicular abscess and were referred to the Zagazig University Hospital Emergency Department between January 2020 and February 2022. The study was prospectively approved by the Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 9871/26-9-2022), and was retrospectively submitted to clinicaltrials.gov in June 2022 (ClinicalTrials.gov ID: NCT05419440). The sample size was 172 patients divided into two equal groups, a laparoscopic group involved 86 patients (group 1) and an interventional radiology group involved 86 patients (group 2). Results Group 1 (laparoscopic drainage group) included 86 patients: 55.8% were males, with a mean age of 41.2 SD 12.2 years-old, while group 2 (interventional radiology group) included 86 patients: 51.2% were males, with a mean age of 36.8 SD 10.9 years-old. The incidence of reported complications in group (1) was 1 (1.2%) for bowel injury, 3 (3.5%) for fecal fistula, 0 (0%) for recurrence, 0 (0%) for pelvic collection and 0 (0%) for mortality while in group (2) were 5 (5.8%) for bowel injury, 0 (0%) for fecal fistula, 3 (3.5%) for recurrence, 8 (9.3%) for pelvic collection and 1 (1.2%). The incidence rates of quality of life in group (1) were 48 (55.8%) for excellent quality of life, 38 (44.2%) for good quality of life and 0 (0%) for poor quality of life, unlike group (2), the incidence rates of quality of life were 12 (14%) for excellent quality of life, 59 (68.6%) for good quality of life and 15 (17.4%) for poor quality of life. Conclusion Laparoscopic management of appendicular abscess was safely applied in a good experienced hand without the need for interval appendectomy.