Long-term effects of appendectomy in humans: is it the optimal management of appendicitis?

ABSTRACT

Introduction

Appendectomy remains the gold standard for treating uncomplicated and complicated appendicitis. However, the vermiform appendix may play a significant role in the immune system (secondary immune function) and maintain a reservoir of the normal microbiome for the human body. The aim of this study was to summarize the long-term effects after appendectomy and discuss whether appendectomy is suitable for all appendicitis patients.

Areas covered

A comprehensive and unbiased literature search was performed in PubMed. The terms ‘appendix,’ ‘appendicitis,’ ‘appendectomy,’ and ‘endoscopic retrograde appendicitis therapy’ were searched in the title and/or abstract. This review summarizes the long-term effects of appendectomy on some diseases in humans and describes three methods including appendectomy, medical treatment, and an ‘organ-sparing’ technique, named endoscopic retrograde appendicitis therapy (ERAT) to treat appendicitis.

Expert opinion

Appendectomy remains the first-line therapy for appendicitis. The patient's problem is appendix, not appendicitis. If we treat appendicitis, the problem should be resolved. During COVID-19, an initial antibiotic treatment of mild appendicitis represents a promising strategy. For patients who are worried about the long-term adverse effect after appendectomy and have a strong desire to preserve the appendix and are aware of the risk of appendicitis recurrence, medical treatment, or ERAT could be proposed.

KEYWORDS:

• Appendicitis
• appendectomy
• endoscopic retrograde appendicitis therapy
• inflammatory bowel disease
• colorectal cancer
• gallstones
• parkinson’s disease
• cardiovascular disease

Article highlights

• The appendix is rich in lymphatic tissue and plays an important role in regulating the immunity and the composition of intestinal microbes.

• Appendectomy remains the first-line therapy in the treatment of uncomplicated and complicated appendicitis because of its definitive, one-time-only treatment, but long-term adverse events after appendectomy has stimulated a debate about the function of the appendix and the importance of its retention.

• The risk of colorectal cancer, gallstones, cardiovascular, and several other diseases are increased after an appendectomy; it is controversial about the relationship between IBD and appendectomy and PD and appendectomy.

• ERAT is a minimally invasive technique to treat uncomplicated appendicitis and preserve the functional appendix and has heated a novel glimpse on an old clinical protocol.

• Large sampled prospective-randomized controlled trials are needed before considering ERAT as an alternative management for patients with uncomplicated appendicitis.

• During COVID-19, initial antibiotic treatment of mild appendicitis represents a promising strategy. For patients who are worried about the long-term adverse effect after appendectomy and have a strong desire to preserve the appendix and are aware of the risk of appendicitis recurrence, medical treatment, or ERAT could be proposed.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.