Objective: Currently, laparoscopic appendectomy is widely practiced for the management of acute appendicitis. Our aim was to compare the safety and the advantages of laparoscopic versus open appendectomy in obese patients in a prospective randomized study. Patients and methods: This prospective study was carried on 80 patients from April 2013 to November 2014. Patients were randomly divided into two groups. The group A: 40 patients were subjected to laparoscopic appendectomy (LA), whereas the group B: 40 patients were subjected to open appendectomy (OA). The demography and the primary outcome measures of the patients such as operative duration, hospital stay, post-operative pain, post-operative complications and patient's satisfaction about cosmesis result were recorded and analyzed. Result: Eighty obese patients with clinical diagnosis of acute appendicitis were included. Operative time was longer in group A (LA) with mean of (77.20 ± 23.04) in comparison with group B (OA) (68.40 ± 6.67). Operative difficulties were encountered in 10% and 20% of cases in group A and B respectively. No conversion in LA was performed in any case. Patients in group A started feeding earlier (7.30 ± 2.45 hours) than group B (18.10 ± 13.25 hours). Mean comparison of postoperative pain by visual analogue scale on day 1, was significantly lower in Group A (4.0 ± 1.89) compared with Group B (6.40 ± 1.71). Length of hospital stay was shorter in Group A (1.35 ± 0.58 days) than Group B (2.40 ± 0.57 days). Chest infection was slightly higher in group B (10%) in comparison to group A (7.5%). The rate of wound infection was higher in OA 20% in comparison with LA 5% (especially in perforated appendicitis cases). Patient's satisfaction in term of cosmesis was highler in group A in comparison to group B. Conclusion: Laparoscopic appendectomy is safe and superior to OA in obese patients with respect to an early discharge, lesser postoperative pain, decreased wound infection, early return to work and a better cosmetic scar. Laparoscopic appendectomy also improves diagnostic ability and excludes other causes of abdominal pain and gives the ability to manage other pathology at the same session.