Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
How good do you think is modern medicine with respect to performing appendectomy correctly for suspected appendicitis? The issue of unnecessary appendectomy in a significant number of cases is provocative in this modern era of advanced imaging techniques.
A recent study by Dr. Das and colleagues studied 912 appendectomy performed for suspected acute appendicitis. All the surgically excised appendix specimens were examined for histopathologal examination. The overall negative appendicectomy rate was 36.40 percent, which is significantly greater than demonstrated in some other studies. The negative appendectomy rate was higher among women than men (40.34 versus 26.80 percent). Even more surprising was the fact that while 409 specimens of the total 912 (44.85%) were assessed as normal appendix by the surgeon during surgery, 77 turned out to have acute appendicitis based on biopsy examination.
The investigators recommended a thorough work-up with pre-operative imaging and diagnostic laparoscopy prior to subjecting a patient presenting with typical clinical presentation for appendicitis.
The above study comes from a developing country and the results may in part be a reflection of scarcity of resources. On the other hand, similar discrepancies may be seen in developed countries based on socioeconomic characteristics. For example, we have history of appendectomy is associated with greater performance of endoscopy suggesting the possibility that patients with abdominal pain use more of health care resources and are more likely to undergo appendectomy.
Above results are also consistent with some other literature including study by Borgstein and colleagues and appropriately titled, “Acute appendicitis--a clear-cut case in men, a guessing game in young women
By the way, above has a silver lining too: we and others have shown that appendectomy protects against development of ulcerative colitis.
An update: Recent data indicates that not all cases of appendicitis require surgery; they may be treated with antibiotics alone.
Have you had appendectomy and did it show acute appendicitis on biopsy specimen? What are your thoughts on lack of improvement in physicians inability to diagnose acute appendicitis despite advances in medicine? Also please share your thoughts on differences in appendectomy rates based on gender and race.