O110 Prophylactic appendicectomy and cholecystectomy prior to prolonged expedition in extreme environments

Abstract

Abstract Introduction Over the past century, there has been a reasonable amount of evidence to support the concept of prophylactic appendicectomy and cholecystectomy prior to commencing prolonged expeditions to extreme environments such as the Antarctic and space. However, the risks and ethics of removing perfectly healthy organs to prevent a possible future complication must be accounted for. We aimed to perform a qualitative review of existing literature on the risks and ethics of prophylactic surgical procedures prior to prolonged expeditions. Methods We conducted a review of PubMed/Medline and Google Scholar databases on the use of prophylactic surgical procedures following ENTREQ guidelines. Results We utilized 23 studies returned in our search to synthesize a body of literature concerning the risks, benefits, and ethics of prophylactic surgical removal of non-essential organs prior to prolonged expeditions. In Antarctic expeditions, the risk of developing acute appendicitis has been projected as high as 43 per 1 million person days. Perioperative complications and risk of death are also high in these prolonged ∼30-year expedition settings. With lack of access to such minimally invasive laparoscopic technologies in extreme environments and unknown exposures, it is anticipated that management would be increasingly challenging with a high risk of complication and death. The risks of surgery must also be considered in individuals with co-morbidities, personal circumstances, and in the context of medical fitness for certification. Conclusion The benefit versus risk analysis is variable. Most literature suggest screening and performance enhancement for explorers undertaking prolonged missions.