Thousands of women face unnecessary appendix surgery each year

Posted: 06/12/2019

A study undertaken by the University of Birmingham in 2019 has found that up to a third of operations performed on women in the UK to remove their appendixes (appendectomy surgery) were unnecessary and those women should instead have undergone investigations for period pain, urinary tract infections or ovarian cysts. Approximately 5,500 healthy appendixes are being removed every year under NHS care.

The study has been published recently in the British Journal of Surgery and attracted considerable attention and comment. This is unsurprising when it is noted that ‘needless appendix removal’ occurred in 28.1% of appendectomies on women in the UK, compared to 10.2% as an average in four other European countries examined. The difference is quite staggering.

Any surgery carries risk, as is well known, but to undergo unnecessary appendix removal as a result of a clinical failure to consider all differential diagnoses and investigate properly, is unsatisfactory and is putting women at risk of complications. It is also, of course, creating further surgical costs for the NHS.

The Birmingham study does suggest that the NHS can be very quick to commit women with abdominal pain to surgery. However, firstly the diagnosis must be supported by the appropriate investigations, and these are likely to include:

• a physical examination of the painful area (abdominal and rectal examination);
• a white blood cell count (looking for infection);
• a urine test (looking for a kidney or bladder problem);
• an abdominal X-ray (to check for appendix stones causing blockage);
• a barium enema (a form of X-ray where the colon is filled with liquid barium to improve visualisation);
• an ultrasound scan (used to identify an enlarged appendix or an abscess and rule out inflammation of the ovaries, fallopian tubes and uterus);
• a CT scan (to check whether the appendix is enlarged or swollen).

It can still be difficult to diagnose appendicitis even after these investigations, simply due to a woman’s individual anatomy. Her appendix may be longer or smaller than usual or can be hidden behind her large colon, making a diagnosis problematic. There are also a number of other conditions that can mimic appendicitis, producing similar symptoms, and these include diverticulitis, pelvic inflammatory disease and some kidney diseases.

When acute appendicitis is diagnosed, as a medical emergency, then removal of the appendix by surgery is required. In this situation, the diagnostic tests must be performed very quickly and the patient taken to theatre as soon as possible, as the time interval between onset of symptoms and rupture of the appendix is usually just 36 to 48 hours.

Alison Johnson, partner in the clinical negligence team at Penningtons Manches Cooper, investigates gynaecology and surgical cases and comments: “Unnecessary surgery is hugely undesirable as it places women at risk of post-operative complications, usually involves a hospital stay and then a recovery period, and generally places stress and worry on the woman and her family. It is imperative that abdominal symptoms are investigated thoroughly and promptly, so that whenever possible, the correct diagnosis is reached and the treatment plan is appropriate. If appendicitis is diagnosed, then surgery may be required, and in the case of acute appendicitis, it is required urgently to prevent an appendix rupture, which sadly can cause long-term implications on a woman’s health and fertility.”

The specialist surgical and gynaecology teams at Penningtons Manches Cooper can help you if you have undergone unnecessary surgery or if your diagnosis and operation was delayed, leading to further injury, such as an appendix perforation.

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