Pamela A. Popper, Ph.D., N.D.

Wellness Forum Health

American doctors are enthusiastic about removing body parts that they deem unnecessary, like gall bladders or uteruses in postmenopausal women.  But all human body parts have a purpose, and with the exception of emergency or trauma, patients should carefully consider the decision to allow them to be surgically removed

The appendix is thought by most people to be useless, and is a common source of pain and discomfort for many people.  But we now know that the appendix serves an important purpose, and that it is a good idea to keep it if at all possible.

The appendix is a thin tube, about four inches in length, that is situated in the lower right abdomen and connected to the cecum. It serves as a reservoir for bacteria that can be used to repopulate the gut microbiome following any illness, such as cholera (which was a regular occurrence in human history, and is still common in parts of the world today) that can affect the microbiome.[i]  This, in turn, reduces the risk of a recurrence of the disease, and protects against the development of other diseases since the gut microbiome plays such a strong role in immune function.

Appendicitis is inflammation of the appendix, and is the most common cause of abdominal pain. If the appendix ruptures, bacteria can enter the abdomen triggering peritonitis, an infection of the tissues lining the wall of the abdomen and covering abdominal organs. This can be fatal, and taking the appendix out is one way to guarantee that the patient won’t die.

But studies show that most of the time, an inflamed appendix does not rupture, and that antibiotics alone can be used to treat it.  Researchers in England performed a meta-analysis of four randomized clinical trials that compared antibiotic treatment to surgery for uncomplicated appendicitis.  The use of antibiotics alone was successful 63% of the time, and patients who took antibiotics instead of having surgery were 39% less likely to have complications than those who had surgery. Only 20% of those treated with antibiotics had to return to the hospital because their symptoms worsened.  The researchers were clear that antibiotic treatment alone is only appropriate for patients with uncomplicated appendicitis.[ii]  Complicated appendicitis involves ruptured, perforated or gangrenous appendicitis.

Another study conducted at Nationwide Children’s Hospital in Columbus Ohio concluded that most children with uncomplicated appendicitis were able to avoid surgery. Treatment with antibiotics was sufficient for resolving the problem.

This study included 102 patients between the ages of 7 and 17 who were diagnosed with acute appendicitis.  Sixty five patients had surgery and thirty seven chose antibiotics instead.  The primary endpoint measured was whether or not the patient had undergone appendectomy at one year.  Secondary outcomes included the incidence of complicated appendicitis, sick days for the child and the parent, and healthcare costs for the year following the event.

For children who were treated with drugs, the success rate was 94.6% at hospital discharge, 89.2% at one year, and 75.7% at 21 months.  The nonoperative group had longer hospitalizations than the surgery group, and two patients were readmitted within 30 days and had laparoscopic appendectomy.

The rate of postoperative complication in the surgical group was 7.7%, while there were no postoperative complications in the patients who had appendectomy a year later.

There was a significant difference in disability days – the non-operative patients averaged 8 days, while the patients who had surgery averaged 21.  As expected, there was a significant difference in costs, with patients treated with drugs alone costing an average of $4219 vs $5029 for those who had surgery.  At one year, costs remained lower in the non-operative group vs the surgical group.[iii]

How important is it to keep your appendix?  While there is little research in this area, a 2011 study provides some clues. Researchers looked at the medical records for hospitalized adults who had Clostridium difficile to determine whether or not having an appendix made a difference in their health outcomes. C diff is a sometimes fatal pathogen that is particularly deadly for hospitalized patients who are treated with antibiotics.

The study included 254 patients, and the researchers reported that those patients without an appendix were four times more likely to have a recurrence of C diff than those patients who still had their appendix. Recurrence occurred in individuals with an appendix in 11% of cases; for those without one the occurrence rate was 48%.[iv]

This new information should result in more careful consideration about how to treat appendicitis.  Removal of the appendix is considered the standard of care. But research shows that outcomes for patients are about the same for those who do and do not have surgery.  Costs were lower for patients treated with drugs alone, but perhaps the most important issue is that those patients who kept their appendix had additional protection against disease, as nature intended, due to the bacterial reservoir in the appendix.

In the case of uncomplicated appendicitis, patients and/or their families should be informed that they in most cases there is no advantage from having the appendix removed, and in fact surgical removal may result in worsening long-term health should the patient elect surgery.

[i] Randal Bollinger R, Barbas AS, Bush EL, Lin SS, Parker W. Biofilms in the large bowel suggest an apparent function of the human vermiform appendix. J Theor Biol. 2007 Dec 21;249(4):826-31

[ii] Varadhan K, Neal K, Lobo D. “Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials.” BMJ 2012;344:e2156

[iii] Minneci P, Mahida J, Lodwick D et al. “Effectiveness of Patient Choice in Nonoperative vs Surgical Management of Pediatric Uncomplicated Acute Appendicitis.”

JAMA Surg. Published online December 16, 2015. doi:10.1001/jamasurg.2015.4534

[iv]Im G, Lin C, Geier S et al. “The Appendix May Protect Against Clostridium difficile Recurrence.”  Clin Gastroenterol Hepatol December 2011;9(12):1072-1077