Background: Debate exists about the benefits of laparoscopic appendicectomy in acute appendicitis. In this study, we compare the safety and efficacy of laparoscopic appendicectomy with open appendicectomy in young patients with acute appendicitis. Methods: This study is a prospective randomized clinical trial conducted in Ain Shams University Hospitals during the period from January 2007 till January 2010. One hundred forty young patients who were diagnosed as having acute appendicitis were randomized into 2 groups: group I included 70 patients who underwent laparoscopic appendicectomy (LA) and group II included 70 patients who underwent open appendicectomy (OA). Results: The mean operative time was significantly longer in the LA group (60±25 mins) than the OA group (45±15 mins) (P<0.01). There was a need for conversion to OA in 3 patients of the LA group (4.29%) due to extensive adhesions. There was no significant difference in the incidence of intraoperative complications between both groups. There was a statistically significant lower incidence of wound infection and wound seroma in the LA group (2.86% and 1.43% respectively) than the OA group (14.29% and 10% respectively) (P<0.05). There was a statistically insignificant higher incidence of intraabdominal collection in the LA group (4 patients, 5.71%) than OA group (2 patients, 2,86%) (P>0.1). The hospital stay was significantly shorter in the LA group (1.5±0.5 days) than the OA group (2±1 days) (P<0.001). The average cost was significantly higher in the LA group (3300±400 LE) than the OA group (1500+200 LE) (P<0.001). Conclusion: LA is safe and effective for the treatment of acute appendicitis as there is no significant incidence of major intraabdominal complications, there is lower incidence of postoperative complications especially wound infection than OA, and there is significantly shorter hospital stay. However, the mean operative time is significantly longer in the LA group, and the cost of LA is significantly higher than OA. Also the incidence of postoperative intraabdominal   collection   is   higher   in   LA   than   OA,   yet   non   significant.