Inflamed appendix critical
Dear Doctor K: Why do doctors remove the appendix when someone has appendicitis? Don’t we need this organ?
Dear Reader: Appendicitis is an inflammation of the appendix. This small, fingerlike tube hangs from the lower right side of the large intestine. It usually becomes inflamed because of an infection or blockage. The condition is quite common; it affects one in every 500 people in the United States each year. (I’ve put an illustration of an inflamed appendix on my website, AskDoctorK.com.)
An appendicitis attack usually begins with abdominal pain that starts just above the navel and moves to the lower right side of the abdomen. Many people also experience loss of appetite, nausea, vomiting and low-grade fever. Other symptoms can include abdominal swelling, pain when the right side of the abdomen is touched and inability to pass gas.
Once a person is diagnosed with appendicitis (or even strongly suspected of having it), prompt surgery usually is performed.
Surgical removal of the appendix is called “appendectomy,” and it has been the go-to treatment for appendicitis since the late 1800s. It is the most common reason for emergency abdominal surgery in the U.S. That’s true in children as well as adults.
In the 1990s, surgeons began to perform the procedure with an instrument called a laparoscope. This is a flexible tube with a light, video camera, and cutting instruments at the end of it. The instrument allows the surgeon to see inside the abdomen, find the inflamed appendix, cut it free and pull it out of the body.
Removing the appendix with a laparoscope allows for several smaller cuts in the wall of the abdomen. This contrasts with the traditional surgical approach, which involves one large incision. Laparoscopic surgery has led to fewer complications, and the average hospital stay is shorter and recovery is quicker compared to traditional surgery.
Why is appendectomy so widely used? For one thing, if untreated, an infected appendix can burst. A potentially deadly infection can spread throughout the abdomen and into the bloodstream, requiring complicated emergency surgery. Prompt removal of the appendix before it bursts helps avoid this dangerous situation.
Also, we don’t know what the appendix does — or if it does anything at all. Removing it has no negative effects on a person’s health. In fact, sometimes when surgeons have to perform abdominal surgery for other reasons (like an inflamed gallbladder), they remove a healthy appendix while they’re at it. That eliminates the possibility of appendicitis developing in the future.
Everyone who has surgery also receives antibiotics. These drugs treat the infection within the appendix, and they reduce the risk of widespread infection if the appendix has already burst as the surgeons are preparing to operate.
In Europe, there is a trend of treating some cases of appendicitis just with antibiotics, not surgery, and then closely observing the patient. Appendectomy is performed only if needed.
In the U.S., this strategy is followed when the patient is too ill undergo surgery. But it hasn’t yet been widely adopted in more routine cases of appendicitis.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.