Long-term effects of appendectomy in humans: is it the optimal management of appendicitis?

Song, Ming-Yang; Ullah, Saif; Yang, Hui-Yu; Ahmed, Md Robin; Saleh, Abd-Arrahman; Liu, Bing-Rong

INTRODUCTION Appendectomy remains the gold standard for treating uncomplicated and complicated appendicitis. However, the vermiform appendix may play a significant role in immune system (secondary immune function) and maintain a reservoir of the normal microbiome for human body. The aim of this study was to summarize the long-term effects after appendectomy and discuss whether appendectomy is suitable for all appendicitis patients. AREAS COVERED A comprehensive and unbiased literature search was performed in PubMed. The terms "appendix," "appendicitis," "appendectomy," and "endoscopic retrograde appendicitis therapy" were searched in the title and/or abstract. This review summarizes long-term effects of appendectomy on some diseases in humans and describes three methods including appendectomy, medical treatment and an "organ-sparing" technique, named endoscopic retrograde appendicitis therapy (ERAT) to treat appendicitis. EXPERT OPINION Appendectomy remains the first-line therapy for appendicitis. The patient problem is appendix not appendicitis. If we treat the appendicitis, the problem should be resolved. During COVID-19, an initial antibiotic treatment of mild appendicitis represents a promising strategy. Patients who are worried about the long-term adverse effect after appendectomy and have a strong desire to preserve the appendix and are aware of the risk of appendicitis recurrence, medical treatment or ERAT could be proposed.