This is about a part of the body most of us know we have but probably rarely think about: Our appendix.
Do you remember being told that we don’t need our appendixes, that they’re vestiges left over from when early humans needed them to digest fibrous materials like tree bark? Well, not surprisingly, it turns out ALL our organs are useful – if not necessary – to the well-being of the body. Nothing is superfluous.
The appendix is a small, finger-shaped pouch branching off the cecum, where the small and large intestines join. The cecum is the start of the large intestine. It’s generally located in the lower right portion of the abdomen.
MONETARY COST OF AN APPENDECTOMY
Appendectomies are the most common emergency surgeries performed in the US. Many doctors even suggest prophylactic removal of a perfectly good appendix when you’re scheduled for some other type of abdominal surgery to prevent any future possible risk of getting appendicitis plus having to cover the cost of an appendectomy later on. (Mercola, 2018)
The median network cost of an appendectomy in the US was $13,199 as of September 2017. This is an estimate of the amount an insurance company might pay plus your additional co-pay. (Vanvuren, 2017)
Note that $13,199 was the median cost. These surgeries cost a lot more in some states (eg, California) and less in some other states. (Won et al, 2017)
“COST-EFFECTIVENESS” OF PROPHYLACTIC APPENDECTOMY
A 2017 article published in Surgical Endoscopy attempted to calculate whether it’s “cost-effective” to undergo a prophylactic appendectomy. The researchers’ findings:
“With our base-case assumptions, including added cost of prophylactic appendectomy of $660, we find that prophylactic removal of the appendix is cost saving for males aged 18-27 and females aged 18-28 undergoing elective surgery. The margin of cost savings depends on remaining life-years and increases exponentially with age: a 20-year-old female undergoing elective surgery could save $130 over a lifetime by undergoing prophylactic appendectomy, while a 40-year-old female would lose $130 over a lifetime. When the risk of the prophylactic appendectomy exceeds the risk of laparoscopic appendectomy for appendicitis or the cost exceeds $1080, it becomes more cost saving to forego the prophylactic procedure….
“Prophylactic appendectomy can be cost saving for patients younger than age thirty undergoing elective laparoscopic abdominal and pelvic procedures.” (Newhall et al, 2017)
That the researchers chose to consider only FINANCIAL savings, and hypothetical ones at that, seems significant – and rather horrifying.
IS THE APPENDIX A USELESS ORGAN?
OLD IDEA: THE APPENDIX IS VESTIGIAL & UNNECESSARY
Contrary to the outmoded belief that the human appendix is vestigial and no longer performs any useful function, here’s what it actually does for us:
“With the help of white blood cells known as innate lymphoid cells, the appendix acts as a reservoir for beneficial bacteria… Once your body has successfully fought and rid itself of a gut infection, the bacteria emerge from the biofilm of the appendix to recolonize your intestines.” (Mercola, 2018) Since we now know the health of our gut microbiome is intimately associated with our health overall, that seems pretty important to me! NEW UNDERSTANDING OF THE APPENDIX’S IMPORTANT FUNCTION
PHYSICAL COST OF AN APPENDECTOMY: ANTIBIOTICS, C. DIFFICILE & THE APPENDIX
The following (weird punctuation and all) is part of pharmacologist professor Dr Sandy Evans’ explanation of why it’s important to have an appendix. See What does your appendix do ? It’s not NOTHING! for her entire conversation.
The appendix to the rescue
The job of the appendix, is to provide the good guys with a safe haven – a place to ride out, decimating events, like diarrhea and antibiotics.
Okay, okay………….. it’s not designed for them to survive antibiotics.
Antibiotics are a modern phenomenon, Mother Nature never saw this one coming, but good design has utility.
And the appendix is DESIGNED.
The appendix is not vestigial
Phylogenetic studies, that is studies comparing different animals, find it is a common feature of animal lineages. It occurs in one form or another, in over 30 different animal lineages. And animals with an appendix in their history, never get rid of it – it’s too useful!
The long narrow pipe, packed full of lymphoid tissue, right at the bottom of your colon, is an important part of your immune system.
Keeping your bacteria safe
It is positioned in such a way, that it can miss a lot of the drama associated with a bad case of diarrhea. As torrents of liquid, rapidly exit the gut, carrying ALL gut residents, good, bad and ugly, OUT, the bacteria holed up inside, barely experience a ripple.
Huddled inside, wrapped under a special sticky cover, known as a biofilm, they “ride” the storm out. When things calm down………..they venture forth and multiply – reseeding your gut.
And things return to normal.
The appendix is needed
It’s an ancient protective system, designed to help organisms survive a serious case of the runs. Something that was not so unusual in times gone by.
Being exposed to “dirty” water and/or “dirty” food, was a common hazard. In fact, it still is a relatively common occurrence in many parts of the world.
Diarrhea can be deadly.
Especially when the diarrhea is accompanied by malnutrition and dehydration. Medical and nutritional interventions have transformed it from a killer to an inconvenience.
Safe haven from antibiotics
Good design……….has utility.
The shape, position, and composition (biofilm) of the appendix, give C.difficile sufferers an advantage. Instead of just C.difficile emerging, following the antibiotic decimation, other gut residents survive too.
And a little competition puts C.difficile back in his place.
People with an intact appendix are 2.5 fold less likely to end up with an overgrowth of C.difficile.
Cultivate the “right” microflora
Maybe you’ve been told, your appendix does “NOTHING”.
That’s not TRUE. It helps maintain the “right” microflora.
You can get by without one, and maybe in the modern world, where diarrhea is not a big health threat, having one is not quite as important for your survival, as it used to be.
But, your appendix can help you “survive” ANTIBIOTIC exposure. And here’s Dr Evans’ excellent video on the same topic: The function of the appendix, what antibiotics do to our gut microbiomes, and surviving Clostridium difficile. She’s from South Africa … in case you don’t recognize the accent:
MOST APPENDECTOMIES MAY BE UNNECESSARY
“Doctors have known for years, and CT scans have proved, that appendicitis often doesn’t lead to a burst appendix. Some physicians have used antibiotics as an alternative to immediate surgery when appendicitis is uncomplicated, meaning the appendix is swollen but hasn’t burst.
“To test this alternative treatment, researchers at Nottingham University Hospitals in England compiled the results of four randomized clinical trials that compared antibiotics and surgery for uncomplicated appendicitis. Here’s what they found:
Antibiotics alone successfully treated appendicitis 63% of the time
People who received antibiotics instead of surgery were 39% less likely than those who underwent surgery to have developed complications such as a perforated appendix, peritonitis, or infection around the appendectomy incision.
About 20% of those treated with antibiotics had a return of pain or other symptoms and needed to go back the hospital; some of these had serious infections brewing.” (Skerrett, 2012)
The study results were published in the British Medical Journal.
In a 2018 Finnish study published in the Journal of the American Medical Association, the research team concluded that “nearly two-thirds of patients with appendicitis can be successfully treated with antibiotics alone.” All 250 patients included in the study had uncomplicated appendicitis – ie, their appendixes were inflamed but had not burst. (Salminen et al, 2018)
In an editorial accompanying the JAMA article, Dr Edward Livingston, deputy editor of the journal, observed that these findings “dispel the notion that uncomplicated acute appendicitis is a surgical emergency.” (Livingston, 2018)
“In the U.S., an estimated 300,000 appendectomies are performed each year, which means some 199,800 people undergo surgery unnecessarily…. Not that antibiotics are without their side effects in damaging the microbiome, but it appears to be the lesser of two evils in this setting.” (Mercola, 2018) MORE INFORMATION
See Dr Joseph Mercola‘s article Two-Thirds of Appendectomies May Be Unnecessary for more information about:
Pros and Cons of Antibiotic Treatment
Other Supporting Research
Signs and Symptoms of Appendicitis
Surgical Alternatives
Natural Treatments for Appendicitis
Fasting as a Potential Treatment for Uncomplicated Subacute Appendicitis
WHY I WANT TO KEEP MY APPENDIX
In 2015 on QUORA, Emmanuel Fabella, MD, internist in private practice in Tulare CA affiliated with the Tulare Regional Medical Center, a former Chairman of the Department of Internal Medicine and ICU Director, provided this answer to the question ‘What is the lifetime risk for appendicitis?’:
“… a model suggests that the lifetime risk of appendicitis in the U.S. is 8.6% for males and 6.7% for females. It is most common between the ages of 5 and 40, with a median age of 28. There were 293,000 U.S. hospitalizations related to appendicitis in 2010.” (QUORA, 2017)
Dr Joseph Mercola puts the overall lifetime risk of appendicitis in the US at 1 in 15. (Mercola, 2018)
A 1 in 15 risk = 6.67%. To me, that’s a relatively small risk against the benefits of keeping my appendix.
Given the usefulness of having a reservoir of beneficial gut bacteria inside my appendix ready and waiting to repopulate my gut microbiome in case I have another serious gut infection like Clostridium difficile or for some reason have to take antibiotics that wipe out my existing healthy probiotic bacteria again, choosing to keep my appendix is a no brainer.
REFERENCES
Evans, S. (2018). What does your appendix do ? It’s not NOTHING! See: https://betterbodychemistry.com/bacteria/appendix-protects-antibiotics/
Livingston, E.H. (9/25/2018). Antibiotic Treatment for Uncomplicated Appendicitis Really WorksResults From 5 Years of Observation in the APPAC Trial. Journal of the American Medical Association, 320:12, 1245-1246. See: https://jamanetwork.com/journals/jama/article-abstract/2703304
Mercola, J. (10/18/2018). Two-Thirds of Appendectomies May Be Unnecessary. See: https://articles.mercola.com/sites/articles/archive/2018/10/17/appendectomy-alternatives.aspx?utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20181017Z1_B_UCM&et_cid=DM240689&et_rid=446564746%0A
Newhall, K. et al. (2017). Cost-effectiveness of prophylactic appendectomy: a Markov model. Surgical Endoscopy, 9:3596-3604. See: https://www.ncbi.nlm.nih.gov/pubmed/28078461
QUORA. (2017). ‘What is the lifetime risk for appendicitis?’ See: https://www.quora.com/What-is-the-lifetime-risk-for-appendicitis
Salminen, P. (9/25/2018). Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial. Journal of the American Medical Association, 320:12, 1259-1265. See: https://jamanetwork.com/journals/jama/article-abstract/2703354
Skerrett, P.J. (4/11/2012). Antibiotics instead of surgery safe for some with appendicitis. Harvard Health Publishing. See: https://www.health.harvard.edu/blog/antibiotics-instead-of-surgery-safe-for-some-with-appendicitis-201204114588
Vanvuren, C. (9/2017). How much does an appendectomy cost? See: https://amino.com/blog/appendectomy-cost/
Won, P. et al. (2017). Regional variations in outcomes and cost of appendectomy in the United States. Journal of Surgical Research, 219, 319-324. See: https://www.sciencedirect.com/science/article/pii/S002248041730433X © Copyright 2018. Joan Rothchild Hardin. All Rights Reserved.
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