PURPOSE: Since laparoscopic appendectomy was first described, various modifications, such as single port incisionless-intracorporeal conventional equipment-endoscopic surgery (SPICES), have been described for reducing pain and improving cosmetic results. In the retrocecal and retrocolic positions, attachments to the lateral peritoneum and cecum may lead to difficulties during SPICES, which is performed with only one port. Here, we present the effects of variations in the position of the vermiform appendix in treating acute appendicitis with SPICES. METHODS: We retrospectively reviewed 52 children who underwent SPICES for acute appendicitis between March 2010 and November 2011 in our institution. One group (group A) consisted of 30 patients (mean age, 10.5 +/- 2.5 years) with retrocecal appendix, while the other group (group B) included 22 patients (mean age, 10.9 +/- 2.3 years) with the appendix lying free in the peritoneal cavity. RESULTS: There were no significant differences between groups in terms of patient age, gender, success rate of SPICES, mean operating time, mean follow-up period, overall complication rates or mean postoperative hospitalization period. CONCLUSION: These results suggest that SPICES is a safe and feasible approach even in patients with retrocecal acute appendicitis.