The diagnosis of appendicitis remains uncertain in female patients and laparoscopy has been suggested as a valid diagnostic tool. The laparoscopic approach has recently also been proposed for the treatment of acute appendicitis, though its real value is still under debate. A clinical and economic prospective evaluation of laparoscopic surgery over a 1-year period in female patients is reported. The study involved 38 patients presenting with signs of appendicitis and assigned to open (18) or laparoscopic surgery (20). The two groups were comparable as regards age and clinical presentation of the disease. The duration of the procedures was similar (60 min). Morbidity was comparable (3 vs 2). The ratio of negative appendectomy (50% vs 44%) was also similar, but the laparoscopic approach enabled a higher number of certain diagnoses (9/10 vs 3/8 p > 0.05). No significant differences were observed in the median postoperative stay (3 days for laparoscopy and 4 for surgery) or in the days needed to return to normal activity (15 vs 18). The cosmetic satisfaction was higher for the laparoscopic patients. The cost of the laparoscopic approach, however, was much higher than for conventional surgery. Our results suggest that laparoscopy is a useful diagnostic tool in female patients, but that laparoscopic appendectomy should be considered with some caution in times of restricted financial resources.