Goals. This research is dedicated to a retrospective analysis to results of diagnostics and treatment of patients with acute appendicitis by using VLS, complicated by various forms of peritonitis. Methods. Attended a retrospective analysis in treatment of 1859 patients with acute destructive appendicitis who underwent videolaparosсopy (VLS). Results. Peritonitis was diagnosed in 771 patients (41.5%): local in 722 (38.9%) patients, generalized in 49 (2.6%). According to the criteria w developed by the institute defined technique of appendectomy — videolaparoscopic or laparotomy access. VLAE attended in 639 patients (34.4%) with local unlimited peritonitis and 12 (0.6%) patients with delimited peritonitis (periappendicular abscess). The conversion carried out in 10 patients (0.5%) with advanced inflammatory process. Indications for laparotomy exposed 33 patients (1.8%), and 17 (0.9%), diagnosed through the VLS the dense appendicular infiltrate, performed abdominal drainage. VLAET performed to 10 patients with diffuse widespread peritonitis , and 24 (1.3%) with generalized and 15 (0.8%) with diffuse — open AE. Conclusion. LWS allowed in 41.5% of patients to establish the nature and prevalence of peritonitis, making 36.1% of them identified indications VLAE, 4.5% and 0.9% of AE with appendicular infiltrate to conservative treatment. It was reasonable to carried out VLAE in 0.5% of patients with diffuse widespread peritonitis. In the event of generalized diffuse peritonitis with intestinal paresis, requiring nasointestinal intubation, considered appropriate appendectomy through the «open» access, in spite of the ability to perform in the present conditions of endoscopic intubation.