The surgical literature supports a negative laparotomy rate of 20% for patients who are explored for the diagnosis of appendicitis. It has been assumed that attempts at decreasing the negative laparotomy rate will increase the perforation rate to above 25%. We reviewed the experience at a community hospital with the treatment of appendicitis in 970 consecutive patients. Close inhospital observation was used to evaluate difficult cases. The negative laparotomy and perforation rates were 10 and 23%, respectively. No patients perforated under observation. The surgical standards for negative appendectomy rate can be revised downward to 10% without fear of increasing the perforation rate.