Objective: Appendectomy is the most common non-gynecological surgery performed during pregnancy. Despite this fact, few studies have evaluated laparoscopy in the pregnant patient. The purpose of this study was to evaluate the safety, feasibility and efficacy of laparoscopic versus open surgery for treatment of suspected appendicitis during pregnancy.Methods: A retrospective review of 65 consecutive pregnant patients undergoing surgery with a working diagnosis of acute appendicitis from 1999-2008 was performed. Preterm delivery was defined as delivery at less then 38 weeks of gestation. Significance was determined by unpaired t-test and Chi-square test.Results: Of the 65 patients, 48 cases were laparoscopic and 17 open. Of the 48 laparoscopic cases, 27% were performed in the 1st, 54% in the 2nd, and 19% in the 3rd trimester, up to the 32nd week of gestation. For the 17 open cases, none were performed in the 1st, 29% in the 2nd, and 71% in the 3rd trimester. Significance was demonstrated between laparoscopic and open group in mean gestational age at time of surgery (18.1 vs. 24.3 weeks, p<0.05) respectively. The negative appendectomy rate was 21.5%, no difference existed between groups. In 5 laparoscopic cases the appendix was not removed secondary to a grossly normal appearance. There were no maternal mortalities. No statistical difference was demonstrated in maternal patient demographics, clinical presentation, time to presentation, appendix pathology, type of delivery (cesarean section vs. vaginal), length of hospital stay, and surgical site infection rate. Follow-up of fetal outcome was achieved in 86% (83% laparoscopic, 94% open) of patients and no significance was demonstrated in fetal loss (1 in laparoscopic group), APGAR score, birth weight, and gestational age at delivery. Independent risk factors for preterm delivery were onset of symptoms >48 hours prior to emergency room (ER) arrival and admission leukocyte count >17 X109/L.(p<0.05). Time to operative intervention was prolonged by use of computed tomography scan or magnetic resonance imaging for diagnosis (19 vs. 9 hours, p<0.001).Conclusions: Laparoscopy is a safe, feasible and efficacious modality in pregnant patients with suspected appendicitis in the first and second trimester. Maternal and fetal outcome were equivalent in both groups. Preterm delivery is associated with prolonged time to ER presentation after onset of symptoms and/or elevated leukocyte count, making prompt recognition and intervention in these patients imperative. “Fast-track” protocols should be developed to rapidly identify this subset of patients and hasten time to surgical consult.