Most people don’t think much about their appendix until something goes wrong with it. Appendicitis, or inflammation of the appendix, might make a doctor order emergency abdominal surgery. But that doesn’t mean everyone needs to have their appendix removed. There’s an ongoing debate in the medical community about whether surgery is always necessary.
What Does The Appendix Do?
The appendix is a narrow, finger-shaped pouch attached to the large intestine, located in the lower right portion of the abdomen. For decades, doctors considered it a vestigial organ – a relic of evolution with no modern purpose.
However, recent studies suggest it may play a modest role in immune function, particularly in early life. Some researchers believe the appendix stores beneficial gut bacteria, repopulating the digestive system after illnesses like diarrhea. Still, its functions aren’t essential for survival, and many people live completely normal lives after having it removed.
What Is Appendicitis?
Appendicitis occurs due to a blockage — often from something like stool, a foreign body or swelling of nearby lymphatic tissue during an infection. Then, bacteria multiply inside the appendix, causing inflammation, swelling and pain.
The classic symptom is a sharp pain that starts near the navel and shifts to the lower right side. You may also experience nausea, vomiting, loss of appetite, fever and abdominal tenderness.
If left untreated, the inflamed appendix can rupture, spilling infectious material into the abdominal cavity. Then, a condition called peritonitis can develop, which requires immediate medical attention and more intensive treatment, sometimes including drainage and antibiotics alongside surgery.
Is Surgery Always Required?
Surgically removing an inflamed appendix has been the standard treatment for over a century. Doctors usually perform appendectomies using general anesthesia, ensuring their patients are completely pain-free during the procedure. Anesthesia usually involves a combination of IV medications and gases like nitrous oxide to put you to sleep. Anesthesiologists will closely monitor you after administering general anesthesia.
Because anesthesia affects the digestive system, patients must fast for eight hours before surgery, other than consuming water. This fasting period helps prevent complications like nausea or vomiting while under sedation.
Traditionally, doctors performed appendectomies by opening the abdominal cavity to remove the appendix. However, minimally invasive laparoscopic techniques involving smaller incisions, minimal scarring and quicker recoveries are more common today.
However, surgery isn’t always the only option. Some trials have shown that it’s possible to treat appendicitis cases without rupture or an abscess with antibiotics alone. Still, there’s a risk of recurrence. Some people who initially respond to antibiotics may experience a return of their symptoms and eventually require surgery.
Doctors weigh several factors when recommending treatment, including:
- Severity and duration of symptoms
- Imaging results like CT scans or ultrasounds
- Your health and age
- The risk of complications if the appendix were to rupture
What Happens During And After Surgery?
If surgery is necessary, it’s usually straightforward. In laparoscopic appendectomy, the surgeon makes a few small incisions and uses a camera to guide the instruments. You may need more extensive surgery if your appendix has burst or you have a widespread infection.
Recovery depends on if the appendix has ruptured. For uncomplicated cases:
- Most patients go home within 24 hours
- Return to normal activities within one to three weeks
- Pain is usually mild and well-managed with over-the-counter or prescription medication
For complicated appendicitis with rupture:
- Hospital stay may last several days
- Recovery could take three to four weeks or more
- IV antibiotics are often necessary
Is Appendix Removal Necessary For Everyone?
Not everyone needs their appendix removed. Most people live their entire lives without any issues. Even patients with appendicitis don’t necessarily require surgery – especially if doctors catch the condition early and it qualifies as uncomplicated.
Appendectomy remains the most reliable way to eliminate the risk of recurrence. It’s also the safest option in more severe cases or when there’s any sign that your appendix might rupture.
Surgery Isn’t A One-Size-Fits-All
Appendicitis is common, but treatment isn’t always black and white. Advances in diagnostics, imaging and antibiotics therapy have opened up new options for patients – though surgery is still the gold standard in many cases.
