Objective:To elucidate if the course of acute appendicitis is influenced by the variable positions of the appendix. The appendix positions were divided into two groups: (i) the anterior group, which included the anterior, the pelvic and the paracaecal positions; and (ii) the posterior group, which included the retrocaecal and retroileal positions. Method: The hospital records of 161 patients who underwent appendectomy for acute appendicitis from January 2000 to June 2001 at Prince of Wales Hospital were reviewed retrospectively. Results: Clinicians' delay in reaching the diagnosis was longer in the posterior group (9.9 h vs 5.8 h; P = 0.043). However, complicated appendicitis (gangrenous changes, perforation or abscess formation) was not associated with the appendix location (P = 0.078). The median operating time for laparoscopic appendectomies lasted longer in the posterior group (77.5 min vs 60 min; P = 0.02). These patients also had a longer hospital stay (6 days vs 4 days; P = 0.049). No difference was observed among patients who underwent open surgery. Conclusion: Appendices in the 'hidden' position did not translate into a higher incidence of complicated appendicitis or postoperative complications except for the slightly longer hospital stay in patients treated by laparoscopy. Therefore, we concluded that the location of appendices does not affect the clinical course of appendicitis in the locality studied.