Objective: Acute appendicitis, as a common clinical acute abdominal condition, has a significant impact on patient prognosis depending on the choice of treatment strategy. This study aims to systematically compare the clinical efficacy and safety of surgical versus conservative treatment in patients with acute appendicitis. Methods: A total of 60 patients with acute appendicitis admitted to our hospital from August 2024 to July 2025 were selected as the study subjects and divided into a surgical group (n = 30) and a conservative group (n = 30) based on the treatment approach. The surgical group underwent abdominal incision appendectomy, while the conservative group received antibiotic therapy combined with symptomatic supportive treatment. Evaluation indicators included the treatment effective rate, symptom relief time, and complication incidence. Results: The treatment effective rate in the surgical group was 96.67%, significantly higher than that in the conservative group (76.67%) (p < 0.05). In terms of symptom relief, the time to relief of abdominal pain (1.25 ± 0.36 days) and fever (1.08 ± 0.29 days) in the surgical group was significantly shorter than that in the conservative group (3.12 ± 0.57 days and 2.89 ± 0.61 days, respectively, p < 0.001). The complication rates in the two groups were 10.00% and 13.33%, respectively (p > 0.05). Conclusion: Surgical treatment for acute appendicitis demonstrates significant advantages in improving treatment efficacy and shortening the time to symptom relief, with a comparable risk of complications to conservative treatment. It is therefore worthy of clinical priority recommendation, particularly for patients without surgical contraindications.