Ligation and Drainage of Appendix Prevents Future Appendicitis IN rat

Background – The appendix is essentially a lymphoid organ which contributes to the production of B and T lymphocytes and is supplemental to the immune system. For many years, removal of normal appendix during other intraabdominal surgeries (incidental appendectomy) was a common practice. The present experimental study was designed to find a procedure in which, while preserving the appendix, the risk of future appendicitis is reduced.Methods – Laparotomy was carried out on four groups of N-Mari rats: 1) obstruction group (n = 10)—the base of the appendix was ligated; 2) milking group (n = 31)—the contents of the appendix were milked into the cecum prior to ligation; 3) drainage group (n = 31)—the contents of the appendix were milked into the cecum prior to ligation and the tip of the appendix was cut, so that mucosal secretions could drain and be absorbed into the peritoneal cavity; and 4) control group (n = 31)—only exploration and manipulation of the appendix via celiotomy, but no surgical procedures, were performed. The blood supply to the appendix was preserved in all animals. All animals underwent a second laparotomy to remove the appendix and detect histopathologic evidence of appendicitis after 30 days. Chi-square and two-tailed Fisher’s exact tests were used to analyze the data.Results – All animals in the obstruction group developed acute appendicitis early in the 24 hours after ligation. Histopathologic evidence of inflammation was detected in 12 of 31 rats in the milking group and in three of 31 subjects in the control group after 30 days. No animal in the drainage group developed appendicitis, but two cases of mucocele were encountered. The combined ligation and drainage protocol did not lead to more inflammation than the control protocol (p = 0.7).Conclusion – These results suggest that combined appendiceal base ligation and appendiceal tip cutting (for draining mucosal secretions into the peritoneum) may be considered as an alternative to incidental appendectomy. Further validation of this technique is required before it can be recommended for application in the clinical setting.