We conducted a retrospective analysis to assess the feasibility of laparoscopic appendectomy in cases of ruptured appendicitis. Between August 1993 and April 1998, a total of 328 laparoscopic appendectomies were performed in Min-Shen General Hospital. There were 34 cases of pathology-proven ruptured appendicitis. Patients were divided into three groups according to the operative findings: group 1 (10 cases) consisted of patients with a perforated appendix with local peritonitis, group 2 (15 cases) consisted of patients with perforated appendix with diffused peritonitis, and group 3 (9 cases) consisted of patients with abscess formation around the perforated appendix. Three cases in group 3 were converted to laparotomy and were excluded from this study. Mean age (+/- SD) was 30 +/- 15 years in group 1, 39 +/- 23 years in group 2, and 37 +/- 13 years in group 3. Duration of symptoms was longer in group 3 (4.2 +/-1.2 days) than in group 1 (1.8 +/- 1.3 days) and group 2 (2.3 +/- 1.2 days). There was no difference in operation time among groups 1 (52 +/- 10 min), 2 (64 +/- 13 min), and 3 (67 +/- 16 min). The time of flatus passage after operation was similar in the three groups (group 1, 17 +/- 11 hours; group 2, 21 +/- 12 hours; group 3, 24 +/- 8 hours). Hospital stay was significantly shorter in group 1 (3.0 +/- 1.1 days) than in group 2 (5.1 +/- 2.2 days) and group 3 (4.2 +/- 1.2 days). There were no complications and no readmissions. Our results indicate that the laparoscopic approach is feasible for ruptured appendicitis with local or diffuse peritonitis and in selected cases with abscess formation. However, prospective randomized controlled trials are needed to determine which procedure is to be recommended.