ABSTRACT Background: Nowadays laparoscopic appendectomy (LA) is the management of choice for acute appendicitis (AA) in simple, uncomplicated cases. For complicated acute appendicitis (CAA), laparoscopic or conventional open appendectomy (OA) is still in debate. Objective: This study aimed to compare minimally invasive LA and traditional OA in CAA cases. Methods: In this study, 44 patients with CAA (22 for LA and 22 for OA) with 18 years of age or older were enrolled. It was conducted in General Surgery Department, Helwan University Hospital. Results: The operative time difference between the LA and OA groups was statistically significant (18.5 minutes shorter in the OA group, (p<0.001). The median length of hospital stay, return to normal activity, and patient satisfaction were significantly better in the LA group (p-values of 0.001, 0.00, and 0.14 respectively). The need for analgesics in the LA group was significantly lower than in the OA group. There were no detectable statistically significant findings concerning the occurrence of surgical findings, postoperative vomiting, postoperative ileus, wound infection, wound dehiscence, or postoperative intra-abdominal collection. Conclusions: Laparoscopic appendectomy management of CAA is feasible, safe, and has numerous advantages over the traditional open procedure in terms of reducing postoperative pain, requiring fewer analgesics, shortening the postoperative hospital stay, having a low incidence of postoperative infectious complications, and allowing a rapid return to daily activities with improved comfort and satisfaction.