Incidental appendectomy--yes or no? A retrospective case study and review of the literature.

OBJECTIVE A retrospective review of appendectomies performed at the University of Kansas Medical Center between January 1, 1989, and January 1, 1994, was conducted. In addition, the literature evaluating effectiveness of incidental appendectomy in preventing future operation and morbidity from appendicitis was reviewed. The results of the two reviews were analyzed to formulate guidelines for the appropriateness of performing incidental appendectomy in association with other operative procedures. METHOD A retrospective review of results of appendectomies performed in 460 patients at the University of Kansas Medical Center with analysis of operative findings, pathology of the removed appendix and operative complications was performed. These results were compared with those of a systematic review of the literature utilizing a Medline search relating to the subject of incidental appendix removal. RESULTS Two hundred sixty-one incidental appendectomies were performed in this study of 460 patients (60%). The procedure was most commonly performed with total abdominal hysterectomy (56%), followed by oophorectomy (15%) and exploratory laparotomy (11%). Morbidity was minimal at all ages. Microscopic pathology was found in 25% of the cases. CONCLUSION The data from the current survey and literature review support incidental removal of the appendix in the young patient (< 35 years old). In patients 35-50 years old the literature is controversial, and the patient's clinical condition and judgment of the operating surgeon should determine whether incidental appendectomy should be performed. However, routine incidental appendectomy cannot be justified in patients greater than age 50.