In our last course, I also briefly mentioned what appendix is ​​while describing the cause, symptoms and treatment of appendicitis in children.  So many questions came from private channels about the appendix…
I will try to answer these questions in the Pediatric Surgeon’s Journal.
Let me clarify the words a little to get rid of the confusion of meaning.
At the junction of the large intestine and the small intestine, there is a finger-shaped bowel extension coming out of the large intestine.  This extension is called “appendix”.  Inflammation of the appendix with infection is called “appendicitis”.  You can follow our previous course for details of how children with appendicitis, of course also adults, have complaints, what diagnostic methods we use, how we treat it with surgery or medication.
But our subject in this course is not appendicitis, it is appendix.
For years, it was thought that the appendix was an organ that remained from the embryological period, lost its function in the development process of humanity, atrophied, and was of no use to the body.  Until researchers uncovered its role in the immune system and the regulation of bacteria in the gut.
Yes, the appendix is ​​home to the gut microbiome and is part of the immune system, thanks to the gut-associated lymphatic tissues it contains.  In this case, with the removal of the appendix from the body, the idea that “the diversity of bacteria in our intestines may decrease and immune functions may be impaired” began to come to the fore.
Many studies have been conducted with the idea that inflammatory bowel diseases, celiac disease, cardiovascular diseases, diabetes, rheumatoid arthritis, osteoarthritis, and even neurological diseases through the brain-intestinal axis may develop without the appropriate microbial response.  In these studies conducted with long-term follow-up of people who have had a high number of appendectomy operations, it is stated that there is a connection between the diseases I mentioned and appendectomy.
In addition, it is claimed that the deterioration of the intestinal bacterial environment can lead to the formation of lung, breast and digestive system cancers.
Colorectal cancers have a significant place in cancer-related deaths in the world and approximately 20% occur due to genetic reasons.  For the most part, the cause is environmental factors.  In recent years, it has been claimed that diseases such as ulcerative colitis and Crohn’s disease may increase the formation of colorectal cancer by creating chronic intestinal inflammation.  It is thought that bacteria in the intestines play a protective role in cancer that will occur due to these diseases.  When we remove the appendix by performing an appendectomy, we also get the protective homes of the intestinal bacteria.
I guess I got you upset however, the situation is not that serious.
In the study, which wrote that colorectal cancers increase after appendectomy, it is stated that this increase occurs on average 3.5-4 years after surgery, and the risk decreases to normal rates after 6-7 years.  This suggests that the change in the gut microbiota may have short-term effects.
Comparative follow-up of approximately 150,000 people who had recently undergone appendectomy and 470,000 who had not, revealed that removal of the appendix did not cause a significant increase in digestive system cancers.
In a study conducted by reviewing 37 articles available in the medical literature on this subject, the problems that may be encountered in the long term after appendectomy were revealed and it was stated that the surgical complication rates are extremely low, Crohn’s disease is more common than the normal population, but ulcerative colitis is less common.  According to this study, appendectomy does not increase the risk of cancer.
Another good news is;  we surgeons think that abscesses and adhesions in the abdomen caused by ruptured appendicitis can cause infertility, but according to this study, appendectomy does not cause infertility either.
 Long story short, you don’t have to live with the worry that a bad disease will happen to you because you have had appendicitis surgery.  However, there is no need to remove the appendix unless necessary.
Yes, we have come to the end of a course again.  I hope I was able to answer the asked questions.  I have written some examples of the articles I mentioned below, you can review them if you want.
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 December 2021
 Prof. Dr. Egemen Eroğlu
Ramussen T et al,: Long Term complications of appendectomy: A systematic review. Scandinavian Journal of Surgery 2018, 107(3) 186-196
Shih-Chi Wu et al,: Association between Appendectomy and subsequent colorectal cancer development: An asian population study. PLOS ONE 2015 10(2) : e0118411
Young Young Park et al,: A link between appendectomy and gastrointestinal cancers: a large-scale population based cohort study in Korea Scientific reports 2020 10:15670
Chi-Ya Yang et al.: Risk of irritable bowel syndrome in patients who underwent appendectomy: A nationwide population-based cohort study. Lancet 23, 100383,June 01, 2020