Although laparoscopic appendectomy (LA) has been accepted by most physicians and patients, there are still some physicians and patients who are negative about it in their clinical practice, even a few general surgeons. Whenever a patient asks if LA can be performed and the physician refuses on the basis of the disadvantages of LA, (I believe) every physician who supports LA feels sorry. Individualized treatment is one of the directions of medical development, and LA is no exception. It is clearly not keeping up with medical developments to adopt the same surgical protocol for acute appendicitis without asking for the specific situation. In acute appendicitis, the appropriate surgical option should be chosen according to the patient’s specific situation. Of course, for physicians, the prerequisite is ta master the LA technique, otherwise there is no way to talk about the choice of surgical modality. LA can be considered in the following cases: 1. Obese patients. Open surgery requires a large incision, difficult exposure, exploration is not easy, and the incision is prone to infection. I believe that every general surgeon is not willing to do open appendectomy for obese patients. 2, the diagnosis is not clear and there are indications for surgery. Facilitate full abdominal exploration. 3, female patients who do not exclude gynecological emergency abdominal disease. I have encountered a patient with a diagnosis of acute appendicitis and laparoscopic exploration for pelvic endometriosis. 4, septic appendicitis. Facilitate laparoscopic irrigation. 5, Those with a strong desire to do LA without obvious contraindications. Open appendectomy can be considered in the following cases: 1, non-obese patients; 2, pediatric patients (LA with pediatric laparoscopic instrumentation has also been reported); 3, those with an onset time greater than 72H, or who have had multiple previous episodes, or after conservative treatment of appendiceal abscess (relative contraindication). Such cases mostly have obvious local adhesions and are difficult to handle laparoscopically. I have handled 3 cases of this type of patients with LA, 1 case was transferred and the other 2 cases took longer time. 4, no LA willing patients. Every new thing needs a long time to be widely accepted, and LA is no exception. As long as we continue to summarize and improve in the process of moving forward, I believe LA will definitely become another gold standard after LC (laparoscopic cholecystectomy).