Background: Appendicular mass is a well-recognised complication of acute appendicitis, and its optimal management remains controversial. While conservative treatment is widely accepted, the necessity of routine interval appendicectomy after successful non-operative management is debated. Aim: To compare the outcomes of interval appendicectomy versus conservative management with follow-up in patients presenting with appendicular mass. Materials and Methods: This prospective comparative study was conducted at a tertiary care teaching hospital over a period of one year (July 2024–July 2025). A total of 100 adult patients diagnosed clinically and radiologically with appendicular mass were included. Patients were divided into two groups: Group A (n=50) underwent interval appendicectomy following initial conservative management, and Group B (n=50) received conservative management with follow-up only. Patients were followed for 12 months. Outcomes assessed included recurrence of appendicitis, need for surgical intervention, complications, and duration of hospital stay. Statistical analysis was performed using Chi-square and Student’s t tests, with p < 0.05 considered significant. Results: Initial conservative management was successful in 90% of patients in Group A and 88% in Group B. No recurrence was observed in Group A, whereas 14% of patients in Group B developed recurrent appendicitis during follow-up, with 10% requiring surgery. Complication rates were low and comparable between the groups. Total hospital stay was slightly longer in the interval appendicectomy group.The total Conclusion: Conservative management of appendicular mass is safe and effective in most patients. Routine interval appendicectomy eliminates recurrence but may not be necessary for all cases. A selective approach with careful follow-up is recommended.