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So you think you need . . . an appendectomy

MagazineMarch 2005 (Vol. 15 Issue 12)So you think you need . . . an appendectomy

Surgical removal of the appendix, or appendectomy, is the most common operation in the West (BMJ, 2002; 325: 505-6): 6-8 per cent of Britons and North Americans will undergo the operation in their lifetime

Surgical removal of the appendix, or appendectomy, is the most common operation in the West (BMJ, 2002; 325: 505-6): 6-8 per cent of Britons and North Americans will undergo the operation in their lifetime. Generally considered a safe and standard procedure, it is frequently unnecessary and more dangerous than doctors would have us believe.

The appendix is a short, finger-shaped tube attached to the large intestine in the lower right abdomen. As part of the lymphatic system, one of its functions is related to immunity.

When bowel contents become blocked (rarely by cancer), the trapped gut bacteria multiply, causing inflammation. If left untreated, it can lead to abscess and perforation (rupture), causing peritonitis, a serious infection which can result in gangrene and, rarely, death.

The emergency removal of an appendix can save a life, but doctors tend to take a surgery-first, questions-later approach, which means that appendicitis is also the most frequently misdiagnosed medical condition. There's a lot of evidence showing that 15-29.6 per cent of all appendices removed are actually normal (Eur J Surg, 2000; 166: 796-802). This means that, in the UK, some 5500-11,000 operations were not necessary.

What doctors don't tell you
This is a serious problem when you consider that the side-effects of an unnecessary appendectomy can be fatal to some age groups.

One study of 805 deaths in Scotland during 1953-1963 reported an overall death rate of 0.06 per cent due to unnecessary appendectomy (Lancet, 1966; ii: 1344-7).

Recent studies show a fatality rate of 2.44 patients per 1000 appendectomies (0.24 per cent) (Ann Surg, 2001; 233: 455-60) - or around 90 people a year in the UK, which is seven times more than the average among young children and the elderly. If a third of these operations were unnecessary, then almost 30 of these deaths each year were due to an operation they didn't even need.

Removing an appendix can cause other life-threatening problems. A trial of 106,763 children undergoing appendectomy found that, 15 years later, there was a higher risk of stomach cancer, a borderline greater risk of non-Hodgkin's lymphoma and a threefold increase in eye cancer (Pediatrics, 2003; 111: 1343-50).

Misdiagnosis occurs because of the variable size and location of the appendix, and because the symptoms of numerous other abdominal, pelvic, urinary and gynaecological problems mimic those of appendicitis. Women are especially prone to errors because their sexual organs are nearby. One report concluded that there was "too strong an emphasis on pain and tenderness, and too little attention paid to duration of symptoms and objective signs of inflammation" (Eur J Surg, 2000; 166: 796-802).

So, what are the symptoms of appendicitis? The first sign is usually pain and tenderness in the lower abdomen, usually accompanied by fever, vomiting and constipation. Other typical symptoms include diarrhoea, nausea, loss of appetite and the frequent passing of urine.

Preventing appendicitis
To reduce the risk of appendicitis, eat a high-fibre diet with lots of green vegetables (especially cabbage, cauliflower, peas, beans and brussels sprouts), and fresh or processed tomatoes (BMJ [Clin Res Ed], 1986; 292: 927-30).

A medical herbalist or clinical nutritionist can help you eradicate a 'grumbling appendix', recurrent bouts of abdominal pain due to previous infections. However, do not self-medicate.

If you suspect a perforated appendix, go straight to hospital. Otherwise, go to bed, eat nothing, drink only water and take no laxatives. Seek professional help to find the appropriate homoeopathic remedy, and take it every 15 minutes for up to 10 doses while waiting for a diagnosis. Helpful remedies include Belladonna 30C, Bryonia 30C, Lachesis 6C and Iris ten 6C (Lockie A, The Family Guide to Homeopathy. London: Hamish Hamilton, 1989). Consult your doctor if there is no improvement within 12 hours.

If you go to hospital, a doctor will examine you, and may recommend diagnostic tests such as X-rays, ultrasound, computed tomography (CT) or laparoscopy. However, these tests will not affect the chances of misdiagnosis or perforation (JAMA, 2001; 286: 1748-53) and may even be potentially hazardous on their own. (For more information on this subject, see the latest edition of Lynne McTaggart's What Doctors Don't Tell You; call 0800 146 054 to order a copy).

Urinalysis can rule out urinary-tract infection and kidney stones, and a blood test is also a reliable indicator of infection. Tenderness on releasing pressure on the abdomen is another sign, as is intense tensing of the abdominal muscles. Women are less likely than men to have appendicitis.

If appendicitis is not clearly indicated, you will be observed and monitored every six to 12 hours for up to 24 hours. At this time, you may wish to continue taking the homoeopathy.

Finally, if you need to have your appendix removed:

* You have two options: appendectomy or acupuncture. In a study of 633 acute appendicitis patients, acupuncture cured 62 per cent of them and improved symptoms in 31 per cent, but was not effective in cases of rupture. Of these patients, 461 were followed-up for 20 years and, during this time, 41 per cent did not need to have their appendix removed (Chin Med J [Engl], 1983; 96: 491-4).

* Take one dose of Arnica 30C as close as possible to the operation to help with the shock of surgery. After the operation, take Arnica again as soon as possible - every three hours on the first day, then twice a day for a week, depending on your rate of healing. The evidence for Arnica is mixed, but it has been shown to be more effective than a placebo for healing bruises (Br Hom J, 1978; 65: 8).

* Seek acupuncture treatment during and after the operation. If you can, find a hospital willing to replace conventional anaesthesia with acupuncture, as it has proved to be an effective epidural anaesthetic in 80 patients undergoing appendectomy. Also, the use of painkillers and antibiotics, and the number of postoperative wound infections, were reduced (Chen Tzu Yen Chiu Acupunct Res, 1992; 17: 87-9). In addition, acupuncture can help prevent postoperative nausea and vomiting (Wien Med Wochenschr, 1998; 148: 454-6).

* Eat the healthiest diet you can, and supplement with arginine, glutamine, omega-3 fatty acids and nucleotides to boost your immune function, reduce the number of days in hospital (BMJ, 2003; 327: 117-8) and help you handle the stress of surgery.

Mita O'Conaill


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