Background: Complicated appendicitis presents unique challenges in surgical management, with laparoscopic and open appendectomy being the two primary approaches. This study aims to compare the outcomes of these techniques. Methods: A cross-sectional study was conducted at KMU-IMS (KMU Institute of Medical Sciences, Kohat), Pakistan from January 2023 to January 2024. Patients aged 18 years and above who underwent laparoscopic or open appendectomy for complicated appendicitis were included. Data on demographics, intraoperative details, and postoperative outcomes were analyzed retrospectively. Results: The laparoscopic group demonstrated shorter hospital stays (3.8 vs. 5.4 days; P = 0.0001), reduced pain scores (2.8 vs. 4.1; P = 0.001), and fewer complications such as surgical site infections (5.5% vs. 14.5%; P = 0.04). Economic analysis revealed patient satisfaction and quality of life scores were significantly higher in this group. Conclusion: Laparoscopic appendectomy offers superior outcomes in terms of recovery time, patient satisfaction compared to open surgery for complicated appendicitis. However, the choice of technique should be tailored to individual patient factors and surgical expertise.