The first appendectomy was performed in 1735 by the French surgeon Amyand at St George Hospital in London, England, and from the second part of the 19th century appendectomy has been the treatment of choice in acute appendicitis. Many controversies still exist despite the three centuries of management of acute appendicitis. Lively debate is currently ongoing regarding the management of appendicitis with the use of antibiotic treatment only and the proportion of minimally invasive surgery is increasing steadily. Many investigations are in progress to establish new laboratory markers to confirm or exclude the diagnosis. The purpose of this article was to review recent suggestions and evidence based trends in the management of acute appendicitis.