Abstract Background: Complicated acute appendicitis is acute inflammation in the appendix complicated by perforation, gangrenous appendicitis, periappendicular mass or abscess. Perforation is the most concerning complication of acute appendicitis and may lead to abscesses, peritonitis, bowel obstruction, fertility issues, and sepsis. Appendicular perfo-ration is associated with increased morbidity and mortality compared with non-perforating acute appendicitis. Appendec-tomy for acute appendicitis is the standard treatment and a common emergency surgical procedure, either via open or via laparoscopy. With the great advances in technology and the surgical techniques, laparoscopic appendectomy has become the novel alternative in the treatment of appendicitis in the last 2 decades. Aim of Study: This study aims to compare open and laparoscopic appendectomy in the management of complicated acute appendicitis as regard operative time, postoperative complications as wound infection, postoperative sepsis, ileus, start of oral intake, length of hospital stay and return to normal activities. Patients and Methods: This study is prospective rand-omized controlled clinical trial, including 50 patients, randomly allocated into 2 groups, 25 patients for each group, group (A) open appendectomy and group (B) complete laparoscopic appendectomy, compared in operative time, postoperative complications as wound infection, postoperative sepsis, ileus, start of oral intake, length of hospital stay and return to normal activities. Results: Statistical analysis of the collected data, in the current study the operative time was significantly longer in the laparoscopic group, howeverlaparoscopic approach had several advantages over open appendectomy, it has less incidence of wound infection, less incidence of post-operative ileus and faster return of patients to normal activities. Conclusion: Laparoscopic appendectomy is safe and feasible surgical option for complicated acute appendicitis.