When do you know you have to have surgery to remove appendix?

Pain in your side not related to exercise. "Rebound" pain, that is, if you press on your side then suddenly release it, there is a sharp pain. Fever not associated with flu. If in doubt, go to the ER. Some places take out the appendix endoscopically without leaving a scar.

Severe pain in your right illiac fossa (that's in between you right hip bone and bottom rib bone) some times you can have diahorrea and vomiting, and you will almost always have a loss of appetite. The pain tends to be worse on movement, or if someone touches the precise area.

If in doubt go to the hospital!!

I'm guessing you mean the symptoms of appendicitis? The first symptom is general stomach aches. This can be followed by loss of appetite, and vomiting. The pain will eventually localize, and be felt most between the naval and the right hip bone. All symptoms are generally accompanied by fever.