Guidelines for therapeutic decision in incidental appendectomy

Abstract

Incidental appendectomy is contraindicated in patients whose conditions are unstable, patients previously diagnosed with Crohn's disease, patients with an inaccessible appendix, patients undergoing radiation treatment, patients who are pathologically or iatrogenically immunosuppressed and patients with vascular grafts or other foreign material. In patients ten to 30 years of age--the age group associated with a higher incidence of acute appendicitis--who are otherwise healthy, incidental appendectomy is effective in preventing morbidity and death associated with acute appendicitis. In patients 30 to 50 years of age, incidental appendectomy should be left to the discretion of the surgeon. In this age group, the physician should give special consideration to the gender of the patient and the desire for future childbirth. In patients more than 50 years of age, the incidence of acute appendicitis decreases and the risk associated with operation and prolonged anesthesia is such that an incidental appendectomy is not beneficial. In mentally handicapped patients less than 50 years of age and who are physically healthy, incidental appendectomy should be performed. An inversion technique should be used in all instances of incidental appendectomy. In otherwise clean cases in which incidental appendectomy is anticipated, prophylactic antibiotics may be of value. Patients undergoing procedures that may compromise access to the appendix in the future should undergo incidental appendectomy.