Children with appendicitis often present with perforation. With the recent development of minimal access surgery and improved delivery of antibiotics, we postulated that hospitalization and postoperative morbidity for this problem could be reduced. We undertook this pilot study to determine the efficacy and safety of managing perforated appendicitis with intravenous antibiotics and performing an interval laparoscopic appendectomy at 6 weeks after presentation. Between June 1, 1995 and September 1, 1995, we admitted 29 patients with appendicitis. Of these, 13 (44%) were perforated. Ten patients with perforated appendicitis were treated by conventional operative appendectomy and antibiotics. Three patients with perforated appendicitis were started on intravenous antibiotics in the hospital and these were continued at home. These patients returned for an interval laparoscopic appendectomy at 6 weeks using all disposable instruments. Intravenous antibiotics were discontinued in both groups when, after being afebrile for 48 hours, the white blood cell and differential counts were normal. Lengths of total hospitalization, charges, and associated morbidity were compared in these two groups. All 3 patients in the laparoscopic group were admitted for 3 days, received home intravenous antibiotics for 7 days, and had a single day of outpatient surgery. The total charges, including those for the disposable instruments, were $12,600 ± 1223 (mean ± SD), and there was no morbidity in this group. Patients in the conventionally treated group had 8.2 ± 5.6 hospitalization days for surgery and antibiotics therapy. Four of these patients also went home on intravenous antibiotic for 10 ± 7.4 days. Their charges were $13052 ± 6419. Two of these patients had minor complications: 1 wound infection and 1 prolonged ileus due to interloop abscesses. Three patients in the conventionally treated group required second operative procedures to drain large intra-abdominal abscesses. This preliminary study shows that antibiotic therapy followed by interval laparoscopic appendectomy is a safe alternative. Total hospitalization is less with this approach and hospital charges can be decreased, especially if all reusable instruments are used for the laparoscopic procedure. A randomized trial comparing these two approaches is warranted.