Acute uncomplicated appendicitis has traditionally been managed by early appendicectomy; however, growing evidence has challenged this paradigm, highlighting the potential role of non-operative treatment (NOT), primarily with antibiotics, as a viable alternative. NOT is associated with reduced immediate postoperative complications, shorter recovery times, and a lower risk of surgical complications. Despite these advantages, concerns remain regarding recurrence, treatment failure, and the potential for missed complicated appendicitis. Recurrence rates following successful initial antibiotic therapy are reported to be between 20% and 40% within five years, necessitating careful patient selection and shared decision-making. This review also explores the role of NOT in the management of acute uncomplicated appendicitis in adults, children, and the elderly, looking especially at its efficacy, recurrence rate, and complications in these groups. While appendicectomy remains the definitive treatment with near-zero recurrence rates, NOT offers a safe and effective alternative for selected patients, particularly those wishing to avoid surgery or those with increased operative risk.