Treatment of appendicitis is continuously evolving. Appendectomy remains the standard for acute cases, whereas antibiotics are increasingly explored for uncomplicated appendicitis, showing comparable short-term outcomes. Around 25% eventually requires surgery within a year. Conservative antibiotic therapy, targeting aerobic and anaerobic bacteria, is viable for selected cases, particularly those without complicating factors. Complicated appendicitis warrants emergency appendectomy, laparoscopic or open. Appendicular lumps are often treated conservatively initially in both complicated and uncomplicated appendicitis, followed by interval appendectomy if risk factors persist. Debates persist over missed malignancies and long-term efficacy with conservative management, despite benefits like reduced pain and quicker recovery compared to surgery. Introduction of routine CT scans can increase success rate of conservative management by identifying underlying pathologies and risk factors for recurrences. Surgical removal remains dominant due to historically higher success rates and concerns over missing neoplasms. Nonetheless, antibiotics present a safe alternative for carefully selected patients.