Abdominal pain is one of the most common causes of emergency department admissions and acute appendicitis is one of the most frequent surgical emergencies in children. To diagnose acute appendicitis and make a decision about appendectomy in the pediatric population is still challenging nowadays, even for experienced clinicians. In fact, the clinical diagnosis represents a synthesis of the medical history, physical examination, laboratory tests and radiographic imaging. An unrecognized diagnosis or delayed surgical removal of an inflamed appendix may result in complications such as perforation, abscess and peritonitis. On the other hand, due to clinical conditions that are similar to acute appendicitis, clinicians' decisions about appendectomy lead to an unnecessary removal of the appendix in 15-30% of cases (1,65). The aim of this study was a comparison of the clinical and histological diagnosis, and other valued parameters between two groups of children: those who underwent laparoscopic and those who had a classic appendectomy. 330 children aged two to 19 years, who were admitted to the Department of Pediatric Surgery at the University Hospital Centre Zagreb, in the period between 2013 and 2016 under suspicion of acute appendicitis, were analyzed in this study. The boys to girls ratio was 1.34:1. All of the children underwent the appendectomy; 83.6% of them had a laparoscopic, and 16.4% a classic procedure. The latter group also comprised those cases who were converted from laparoscopic to classic appendectomy. Concordance between the macroscopic surgical and microscopic pathological diagnoses was low. In the group of laparoscopic appendectomy, the diagnoses were correlated in 46.2%, and among those who underwent classic appendectomy in 35.2% of the cases. Higher Alvarado scores (average ≥7) point to phlegmonous or gangrenous acute appendicitis. A perforated appendix was less common among children who underwent laparoscopic appendectomy (10.2% in comparison with 32% in the other group). 90% of all innocent appendices were found in the laparoscopic appendectomy group. Furthermore, the negative appendectomy rate was higher among girls (19.9%) than boys (6.3%). Periappendiceal abscess after perforation was a more common intraoperative assessment in the classic appendectomy group (66.7% of all abscesses). Complications associated with appendectomy, infection of the surgical site and intraabdominal abscess, had the same incidence pattern – they occured rarely and with no statistically significant difference between the groups.