Systematic review of clinical outcomes after prophylactic surgery

Abstract

INTRODUCTION Prophylactic appendicectomy is performed prior to military, polar and space expeditions to prevent acuteappendicitis in the field. However, the risk-benefit ratio of prophylactic surgery is controversial. This study aimed to systematicallyreview the evidence for prophylactic appendicectomy. It is supplemented by a clinical example of prophylactic surgeryresulting in life-threatening complications.METHODS A systematic review was performed using MEDLINE® and the Cochrane Central Register of Controlled Trials.Keyword variants of 'prophylaxis' and 'appendicectomy' were combined to identify potential papers for inclusion. Papers relatedto prophylactic appendicectomy risks and benefits were reviewed.RESULTS Overall, 511 papers were identified, with 37 papers satisfying the inclusion criteria. Nine reported outcomes afterincidental appendicectomy during concurrent surgical procedures. No papers focused explicitly on prophylactic appendicectomyin asymptomatic patients. The clinical example outlined acute obstruction secondary to adhesions from a prophylacticappendicectomy. Complications after elective appendicectomy versus the natural history of acute appendicitis in scenarios suchas polar expeditions or covert operations suggest prophylactic appendicectomy may be appropriate prior to extreme situations.Nevertheless, the long-term risk of adhesion related complications render prophylactic appendicectomy feasible only when theshort-term risk of acute appendicitis outweighs the long-term risks of surgery.CONCLUSIONS Prophylactic appendicectomy is rarely performed and not without risk. This is the first documented evidence oflong-term complications following prophylactic appendicectomy. Surgery should be considered on an individual basis bybalancing the risks of acute appendicitis in the field with the potential consequences of an otherwise unnecessary surgicalprocedure in a healthy patient.