Acute appendicitis is one of the commonest causes for acute abdomen in children worldwide. In Ethiopia appendicitis accounts for 12% of emergency paediatric surgery and in the Congo it constitutes 30% of paediatric visceral surgery. Mortality from appendicitis is up to 4% in some SSA settings and morbidity high with wound infection rates up to 60% and wound dehiscence in up to 25%. Conversely, mortality from appendicitis in HICs is 0.04% and only 0.006% in children aged 9-19years. The LCoGS has listed laparotomy as one of three bellwether procedures that must be safe and available at all institutions providing first level care.