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This prospective randomized study aimed to evaluate the surgical outcomes of single-incision laparoscopic appendectomy (SILA) comparing with open appendectomy (OA) and standard 3-port laparoscopic appendectomy (SLA) in the treatment of acute appendicitis (AA).Adult patients older than 18 years presenting with AA were randomized into 3 groups to undergo OA, SLA, and SILA from September 2010 to May 2011. The groups were compared with regard of patient’s characteristics, perioperative findings/complications, operative time, pain severity, analgesic requirement, time to oral tolerance and flatus, length of hospital stay, and cosmetic results.A total of 75 consecutive patients enrolled in the study. Each group included 25 patients. The groups showed no significant differences in patient’s characteristics. The mean operative time was significantly longer in SILA than OA with a mean difference of 7 minutes (P<0.05). Postoperative pain after OA were significantly higher than SLA and SILA (P<0.05). The average time to oral tolerance and flatus was significantly higher in OA than the laparoscopic groups with a mean difference of 1 and 2.5 hours (P=0.04 and 0.023, respectively). The length of hospital stay in SLA and SILA was significantly lower than OA with a mean difference of 0.8 days (P<0.05). There was no difference in overall complications between the groups. There was no difference between SLA and SILA in terms of surgical outcomes.Either SLA or SILA offer patients faster recovery period with acceptable complications than OA. Hence, laparoscopic approach might be considered as first option in the treatment of AA. However, all 3 techniques provide equivalent clinical outcomes despite the significant findings. Therefore, technique selection is based on surgeon’s decision, experience, and availability of laparoscopic instruments.