Who needs to have an appendicectomy?

Acute inflammation of the appendix (appendicitis) is the most common indication for appendicectomy.

Patients admitted acutely to hospital with a rather long history of acute right lower abdominal pain (5 days or more) may be found to have a mass in the abdomen, called “appendicular mass”. This is the result of the body’s defence mechanisms, including the bowel and a fatty protective apron inside the abdomen called ‘omentum’ wrapping themselves around the inflamed appendix to stop the spread of infection to the rest of the body.

Traditionally surgeons have treated such patients with antibiotics and have avoided surgery due to its considerably increased difficulty, and planned to remove the appendix, if necessary, some 2-3 months later when the inflammation has all resolved. However, the inflammation may not settle and may progress in perhaps 1 of 5 patients. In addition, the inflammation may recur while someone is awaiting an appendicectomy. More importantly, what was thought to be an ‘appendicular mass’ may turn out to be something more serious that needs prompt surgery.

For all these reasons, we have adopted an aggressive approach to the treatment of ‘appendicular mass’, and offer a laparoscopic appendicectomy to all these patients soon after their acute admission to hospital. You may read our publication on this matter by clicking on this link: Early laparoscopic appendectomy for appendicular mass.

Occasionally, at the time of the operation in someone who is suffering acutely with right lower abdominal pain suspicious of acute appendicitis, the appendix and the bowel appear normal. Under these circumstances, some surgeons elect to remove the appendix as there is a 1 in 4 or 1 in 5 chance of the appendix being inflamed when examined under the microscope. The significance of this microscopic inflammation of the appendix, however, is uncertain.

Some patients who have complained about a number of years with recurrent pain in the right lower abdomen that has rarely been severe enough to warrant an urgent admission to hospital may have what people call a ‘niggling appendix’. They would commonly have undergone several investigations to find out the cause of the pain, and usually, these tests prove normal. The selective removal of the appendix under these circumstances using the laparoscopic approach, a very low-risk procedure, may help some (perhaps less than half) of these patients.

Sometimes gynaecologists remove a normal appendix at the time of surgery on the womb (uterus) or the fallopian tubes. The benefit of such an ‘incidental’ appendicectomy, however, is not clearly established.