PURPOSE: Laparoscopic appendectomy (LA) is currently more popular than an open appendectomy (OA), because of its advantages, such as a decrease in postoperative pain, short hospitalization and quick recovery. On the other hand, the efficacy and safety of a laparoscopic appendectomy for complicated appendicitis is controversial. Therefore, this study compared the efficacy and safety of LA and OA. METHODS: This study reviewed retrospectively 262 patients with perforated appendicitis who underwent ether open or laparoscoic appendectomy between January 2001 and December 2010. The medical record and video were used to collect data. The operative time, length of hospital stay, time to diet, time to remove drain and complications were assessed. RESULTS: There were 207 and 55 patients in the OA and LA group, respectively. The operation times were significantly longer in the LA group than the OA group (OA group 68.25+/-33.08 vs. LA group 90.80+/-47.64 min) (p<0.05). The length of hospital stay was longer in the OA group than the LA group (OA group 10.96+/-5.24 vs. LA group 8.86+/-5.18 days) (p<0.05). The time to diet and time to remove the drain was longer in the OA group than the LA group (p<0.05). The postoperative complication rate was similar in the two groups. CONCLUSION: The operative time was longer in the LA group but the length of hospital stay, time to diet, and time to remove drain was longer in the OA group. Such merits show that laparoscopic appendectomy is a good surgical option for perforated appendicitis.