Every case of appendicitis requires immediate removal of the appendix.

Appendectomy became one of surgery’s great successes. Before reliable diagnosis and treatment, appendicitis could progress to perforation, peritonitis, and death, so removing the inflamed appendix promptly was a rational life-saving rule.

For more than a century, that rule hardened into an absolute: diagnosed appendicitis meant surgery.

Modern imaging made it possible to distinguish uncomplicated appendicitis from perforation, abscess, and other higher-risk disease more reliably.

Randomized trials then tested antibiotics-first treatment in carefully selected uncomplicated cases. Many patients recovered without immediate surgery, showing that appendectomy was not biologically mandatory in every case.

The tradeoff matters. Some patients later experience recurrent appendicitis or ultimately require surgery, and factors such as an appendicolith can change the risk.

Appendectomy therefore remains a standard, definitive, and often preferred treatment.

The correction is a narrowing, not a reversal of surgical practice: selected uncomplicated cases can reasonably begin with antibiotics after informed discussion of recurrence and treatment-failure risk.