The publication of the Appendicitis Acuta (APPAC) trial in JAMA by Salminen et al1 generated significant debate about the best way to treat this common disease. This high profile study challenged more than 100 years of practice, attracted extensive media coverage, and sparked animated debate among physicians about the safety and efficacy of antibiotics therapy for treatment of uncomplicated appendicitis. This Viewpoint reviews the study results, outlines both sides of an ongoing debate, and provides recommendations for surgeons who will be confronted by patients questioning whether they need surgery.