Elective appendectomy performed during cesarean delivery does not increase patient illness, according to results of a clinical trial.
The appendix is a small worm-shaped structure that extends from the first portion of the large intestine and has no apparent function. If a fecal ball blocks the inside, inflammation and infection of the appendix (appendicitis) can occur which necessitates prompt surgical removal to avoid potentially serious complications.
With elective appendectomy, the appendix is removed when no inflammation or infection is present in the hopes of preventing problems in the future.
Elective appendectomy at the time of cesarean section is controversial, Dr. Christy Pearce at the University of Tennessee, Chattanooga, and colleagues note in their report. Some small studies have suggested an increased risk of infection and complications, they explain.
"Based on (the current findings) and the calculated benefit of (elective) appendectomy, we believe that appendectomy at the time of cesarean delivery can be considered safely in selected patients," the study team concludes in the American Journal of Obstetrics and Gynaecology.
Appropriate patients for elective appendectomy during c-section include "women with (fecal balls in the appendix) and/or an abnormal appearing appendix, a history of pelvic pain, endometriosis, or anticipated... adhesions," when portions of intestine and other abdominal organs stick to each other.
The study featured 93 pregnant women who were randomly assigned to undergo or not undergo appendectomy during their c-section.
Appendices were inspected in both groups and appendectomy was performed on all women in the c-section/appendectomy group and only in the c-section-only group if warranted.
Performing appendectomy increased operative time by only nine minutes, and it was not associated with an increase in complications, according to the team.
The researchers also note that examination of the appendix after removal revealed a high rate of disease that was not otherwise apparent. Specifically, they found nine abnormalities that included acute appendicitis in two patients.
"It is not our aim to argue the wisdom of prophylactic appendectomies in all patients with cesarean delivery," Pearce and colleagues write. "However, (visual and tactile inspection) of the appendix at the time of cesarean delivery is a plausible guide to the identification of candidates for elective appendectomy and the enhancement of patient outcomes."