Recent advancement in diagnostic technology and availability of effective antibiotics provide us an opportunity to revise our approach in the management of acute appendicitis. This clinical trial was done on 200 patients of acute appendicitis, according to set criteria, 20% underwent primary surgery  and 80% primary conservative (antibiotics) treatment. 90% of those treated conservatively recovered, 10% needed surgery within 48 hrs. due to treatment failure and 11.25% were operated for recurrence during one year follow up.