Objective To compare laparoscopic appendectomy (LA) with open appendectomy (OA) in the treatment of appendicitis complicating gangrene,perforation and abscess in children.Methods This study included 614 consecutively admitted patients with acute complicated appendicitis undergoing laparoscopic (267 cases) or open (347 cases) appendectomy.Clinical outcomes were compared between the 2 groups in relation to operative time,length of hospital stay,postoperative complications and in hospital cost. Results There was no mortality.Conversion to open surgery was necessary in 7 patients in LA group.Laparoscopic appendectomy was associated with a shorter hospital stay (4.6 d vs.8.1 d,P =0.00),lower incidence of wound infection(5.3％ vs.12.8％,P =0.03),less bowel obstruction(5.0％vs.10.0％,P =0.04) and nosocomial infection (9.7％ vs.18.3％,P =0.04).Intra-abdominal abscess formation was significantly higher after laparoscopic surgery (4.1％ vs.1.1％,P =0.04 ).The cost of treatment and operative time were higher in the laparoscopic group than in open appendectomy,however,there was no statistically significant difference. Conclusions Laparoscopic technique is a safe and clinically beneficial operative procedure for complicated appendicitis in children with short hospital stay,early recovery,good cosmetic appearance,and low complication rate,except for a higher incidence of intraabdominal abscess.