PURPOSE: Currently the substantial clinical benefits of single-port laparoscopic appendectomy (SLA) over conventional three-port laparoscopic appendectomy (CLA) are equivocal. The aim of this study was to compare surgical outcomes between SLA and CLA in children with acute appendicitis. METHODS: A single blind prospective randomized single center study was performed to compare the surgical outcomes of SLA and CLA. A total of 105 patients were randomized and various parameters were analyzed, 52 patients with SLA and 53 patients with CLA between July 2013 and March 2014. Patients with sonographically confirmed acute appendicitis were randomly assigned to receive either SLA or CLA. The outcome measurements were operating time, wound complication, and intraperitoneal morbidities, postoperative pain score and cosmetic result score. RESULTS: Operating time is significantly longer in SLA (70.4+/-26.7 minutes vs. 58.0+/-23.4 minutes; p=0.016). There were no significant differences in the postoperative wound complication rate and intraperitoneal morbidities between two groups. There were no significant differences in postoperative resting pain score (6.6+/-2.5 vs. 6.3+/-2.5; p=0.317) and activity pain score (6.9+/-2.4 vs. 6.3+/-2.5; p=0.189), and the cosmetic result score (9.2+/-1.1 vs. 9.1+/-1.4; p=0.853). CONCLUSION: Although SLA would be a safe and feasible procedure in children, SLA could not demonstrate the clear benefit over CLA.