Three-port (trocar) laparoscopic appendectomy is the standard treatment for acute appendicitis and previous studies have compared to single-incision approach, however, they often include both pediatric and adult patients and fail to account for surgeons’ experience, leading to variability in outcomes. This systematic review and meta-analysis aims to address these literature gaps by focusing on adult patients and controlling for surgeon expertise. We conducted a comprehensive search of randomized controlled trials comparing single-incision laparoscopic appendectomy (SILA) and conventional laparoscopic appendectomy (CLA) up to November 2024. We assessed the length of hospitalization, operative duration, postoperative complications, and surgical wound infections. Data were synthesized using random-effects models to account for variability among studies. The meta-analysis included four studies with a total of 408 patients, comprising 202 in the single-incision laparoscopic appendectomy (SILA) group and 206 in the conventional laparoscopic appendectomy (CLA) group. For the length of hospitalization, no statistically significant difference was observed, with a weighted mean difference (WMD) of 0.07 days (95% CI − 0.32 to 0.47, I ² = 0%, p = 0.72). Similarly, the operative duration showed no significant difference, with a WMD of 4.49 min (95% CI − 7.02 to 16.00, I ² = 89%, p = 0.44). The analysis of postoperative complications also revealed no significant difference between the groups, with an odds ratio (OR) of 1.32 (95% CI 0.69 to 2.51, I ² = 0%, p = 0.40). Surgical wound infections were found to be comparable, with an OR of 1.14 (95% CI 0.46 to 2.83, I ² = 0%, p = 0.78). Sensitivity analysis indicated that the results were statistically significant regarding operative duration when Kim et al. was excluded from the analysis. SILA and CLA yield comparable outcomes in terms of hospitalization length, operative duration, and complications, suggesting that both techniques are viable options for the management of acute appendicitis in adults. Further studies investigating overall cosmesis, patient satisfaction, and postoperative pain are warranted to optimize surgical approaches. PROSPERO registration: CRD42024612596.