Background: During laparoscopic appendicectomy, the appendix may be removed either directly through the port or within a specimen retrieval bag. Although bag use is often promoted to minimise wound contamination, its routine application, particularly in uncomplicated appendicitis, remains contentious. Existing evidence is inconsistent, and practice varies considerably across centres. This review aimed to synthesise the literature comparing bag versus non bag extraction and to highlight areas requiring further investigation. Methods: A systematic review and meta-analysis (1980–2025) was conducted in accordance with PRISMA guidelines, including studies reporting postoperative outcomes following laparoscopic appendicectomy using either extraction technique. Both comparative and non-comparative designs were eligible. Primary outcomes were total surgical site infection (SSI), extraction port site infection (EPSI), and intra-abdominal abscess (IAA). Random effects meta-analysis was performed, with results presented as risk ratios and (95% CI). Heterogeneity was assessed using I2, with values >50% considered significant. Results: There were 2055 studies identified of which 13 met the inclusion criteria (1 randomised controlled trial (RCT), 1 quasi-RCT, and 11 Comparative studies). Pooled estimates showed: • SSI RR 0.6 (0.2–1.3), p = 0.2, I2 = 91.8% (86.8–94.9); • EPSI RR 0.7 (0.2–2.1), p = 0.5, I2 = 42.4% (0.0–78.8); • IAA RR 0.7 (0.5–1.0), p = 0.06, I2 = 33.8% (0.0–78.2). Conclusions: Evidence comparing bag and non-bag extraction during laparoscopic appendicectomy remains limited and heterogeneous. While pooled data suggest possible differences in IAA in favour of using a retrieval bag, variability in definitions, operative techniques, and reporting standards precludes definitive conclusions. Robust prospective comparative studies are needed to determine whether routine use of a specimen retrieval bag meaningfully reduces postoperative complications.