Appendectomy Group Research Articles

Evaluation of a Possible Inflammatory Response after Appendectomy for Non-Perforated Appendicitis in Children

The inflammatory process in the post-appendectomy period is not well characterized. In a pilot study, we prospectively followed the kinetics of different inflammatory mediators before and after appendectomy in children, and compared the results of the groups open appendectomy (OA) and laparoscopic appendectomy (LA). Levels of sP-selectin, tPA, MCP-1, IL-6, IL-8, sVCAM-1, and sCD40L were measured before appendectomy and on the next three consecutive days in the serum of 25 children (16 males and 9 females) aged 7 - 16 years (mean 12.6+/-2.47 years) with non-perforated acute appendicitis. LA and OA were performed in 16 and 9 patients respectively. None of the markers of inflammation differed significantly by surgical approach at any point of observation. However, sP-selectin, MCP-1 and sVCAM-1 levels were found to have significantly different postoperative kinetics with a trend towards higher values in the laparoscopic group compared to the open appendectomy group (p=0.034, p=0.016 and p=0.025, respectively). The cytokines sP-selectin, MCP-1 and sVCAM-1 may play a role in the possible post-appendectomy cytokine activation after non-perforated appendicitis. Since this phenomenon is more evident after LA than after OA, the contribution of the different LA procedures has to be further investigated.

Appendicectomy and Cholecystectomy Using Single-Incision Laparoscopic Surgery (SILS): The First UK Experience

Single-incision laparoscopic surgery (SILS) has the potential advantages of reduced postoperative pain and reduced port-site complications. Careful attention to closure can lead to virtually "scarless" surgery. In this article, we present our first experiences with SILS appendicectomy and cholecystectomy. SILS appendicectomy and cholecystectomy was performed in 12 and 14 patients, respectively. Data were collected prospectively and analyzed retrospectively from case notes and the theater database. The average operating times were 61.3 and 142.9 minutes for SILS appendicectomy and SILS cholecystectomy, respectively. There was a good correlation between increasing experience and a reduction in operative time with Pearson's coefficient being -1 for appendicectomy and -0.56 for cholecystectomy. There were no postoperative complications in the SILS appendicectomy group. One patient in the SILS cholecystectomy group suffered a postoperative biliary leak from an accessory duct of Lushka. In our series, we have demonstrated SILS to be a safe and efficacious method for appendicectomy and cholecystectomy. Further studies are required to investigate any potential advantages of this method over standard laparoscopic techniques.

Laparoendoscopic single-site surgery appendectomy

Laparoscopic appendectomy via the three-trocar technique is widely used for appendectomy. This report describes the initial experience with laparoendoscopic single-site surgery (LESS) appendectomy. Between December 2008 and March 2009, patients with acute appendicitis admitted to the General Surgery and Emergency Unit of the authors' institution who agreed to undergo LESS appendectomy were included in a prospective study. All operations were performed by the same surgical team specially trained in this type of emergency surgery. The umbilicus was the sole point of entry for all patients, and the same operative technique was used in all cases. The data for patients undergoing LESS appendectomy were compared with the data from an uncontrolled group of patients undergoing standard laparoscopic appendectomy during the same study period. The LESS and standard appendectomy groups included 15 patients each. The LESS procedure was performed successfully for all the patients, and none required conversion to an open procedure or a conventional laparoscopic appendectomy by the addition of more entry ports. The mean operating time of 51 min in the LESS group was not significantly different from the 46 min in the standard laparoscopic appendectomy group. In this study, LESS appendectomy was technically feasible and safe, representing a reproducible alternative to standard laparoscopic appendectomy.

Postoperative bowel obstruction after laparoscopic and open appendectomy in children: a 15-year experience

Purpose The purpose of the study was to determine and evaluate the incidence of postoperative bowel obstruction (PBO) after laparoscopic and open appendectomy in children. Material and Methods The medical files of children who have undergone an appendectomy, either via the laparoscopic or open approach, at our department from 1992 until 2007 were reviewed. Collected data included age at appendectomy, initial surgical approach, time interval to PBO, and type of definitive treatment. The incidences of PBO after laparoscopic and open appendectomy were compared with the χ 2 analysis. Results From the 1684 children who were found, 1371 had nonperforated appendicitis and 313 had perforated appendicitis. Laparoscopic appendectomy was performed in 954 patients of the nonperforated group and in 221 of the perforated group. Open appendectomy was performed in 417 and 92 patients of the 2 groups, respectively. Overall, the incidence of PBO development was 2.2%. In the laparoscopic appendectomy population, a significantly low incidence of 1.19% of PBO development was detected, compared with the 4.51% of the open appendectomy group ( P < .0001). Conclusion Laparoscopic appendectomy diminishes the potential of PBO development. The overall incidence of PBO is not related to the severity of the disease but only to the initial operative approach.

Do not rush into operating and just observe actively if you are not sure about the diagnosis of appendicitis

The aim of this study was to determine whether the admission and active observation of children where the diagnosis of acute appendicitis is uncertain is a safe and effective way to improve the diagnostic accuracy of appendicitis and safely reduce the incidence of negative laparotomies without increasing complications. We performed a retrospective cohort study of children who presented with a complaint of right lower quadrant pain and were hospitalized with a diagnosis of appendicitis or suspected appendicitis from 1 January to 31 December 2007. A total of 569 patients were included in the study. The mean age was 9.5 +/- 3.2 (range 1.1-17) years. The number of patients directly operated on with a diagnosis of appendicitis was 186 (32%) from the total of 575 while 389 patients (68%) were observed in the surgical ward as the examination and/or investigation findings were equivocal. Of the 383 patients admitted for observation, 173 (45%) were operated on with a suspicion of appendicitis after 14.4 +/- 6.7 h while 210 (55%) were discharged after 1.1 +/- 1.2 days as there seemed to have no surgical problem. Our total negative appendectomy rate was 4% (14/350) and total perforation rate was 37.4% (131/350). The patients operated on directly and those operated on after observation were similar, and there was no difference for the preoperative duration of symptom, histopathological diagnosis, postoperative complication rate, postoperative inpatient days and hospital charges. Total hospitalization duration was significantly longer and the hospital charges significantly higher in the negative appendectomy group. Both the features and results and the complication rates and costs of the group operated on after observation were the same as the directly operated on group. However, patients undergoing a negative appendectomy stayed as inpatients longer than only observation patients with higher treatment charges. We could therefore decrease the negative appendectomy rate, the associated cost and duration of hospitalization without causing extra complications if we observe and investigate patients with right lower quadrant pain with a doubtful diagnosis and did not operate on them directly.

Laparoscopic Appendectomy in Children with Perforated Appendicitis

Purpose: It is controversial to do laparoscopic appendectomy in children with perforated appendicitis. Recently, we have adopted laparoscopic appendectomy as a first-choice method in children with perforated appendicitis. We investigate the results of laparoscopic appendectomy in perforated appendicitis and compare it with open technique. Methods: We studied retrospectively the patients who underwent the appendectomy by either a laparoscopic or open technique for perforated appendicitis between January 2001 and December 2005. There were 117 patients in the open appendectomy (OA) group and 45 patients in the laparoscopic (LA) group. Results: The operation times were significantly longer for the LA group than for the OA group (OA group 76.3±23.7 vs. LA group 95.4±32.4 min) (P＜0.05). The hospital days were also longer in the LA group than the OA group (OA group 8.7±4.4 vs. LA group 11.0±6.3 (days)). However, there was no difference in time to diet (OA group: 5.0±3.3 vs. LA group: 5.4±2.9 (days)) (P＞0.05) and in the rate of complications (OA group: 36/117 vs. LA group: 13/45) (P＞0.05) between the two groups. The incidence of postoperative ileus, intraabdominal abscess and wound infection was lower in LA group, but not significantly. Conclusion: Operation times and hospital days were longer in the LA group. But the incidence of complication was similar between the two groups. Considering little postoperative scar and less pain, laparoscopic appendectomy could be regarded as the optimal surgical therapy in children with perforated appendicitis.

Clinical Outcomes of Laparoscopic Versus Open Appendectomy

Appendectomy, being the most common surgical procedure performed in general surgery, is still being performed by both open and laparoscopic methods due to a lack of consensus as to which is the most appropriate method. Because further trials are necessary and few such studies have been performed in developing countries, we decided to evaluate the outcomes of the 2 procedures to share our experience with the international community. Consecutive patients with suspected acute appendicitis who underwent laparoscopic (LA) (n=48) and open (n=52) appendectomy (OA) over a period of 3 years were studied. Clinical outcomes were compared between the 2 groups in relation to operative time, analgesia used, length of hospital stay, return to work, resumption of a regular diet, and postoperative complications. Mean age of patients was 25.8 years in the laparoscopic and 25.5 years in the open group. Patient demographics were similar in both groups (P>0.05). There was significantly less need for analgesia (1.0+/-0.5 in LA and 1.5+/-0.6 doses in OA), a short hospital stay (1.4+/-0.7 in LA and 3.4+/-1.0 days in OA), early return to work (12.6+/-3.3 in LA and 19.1+/-3.1 days in OA), and less time needed to return to a regular diet (20.1+/-2.9 in LA and 22.0+/-4.7, P<0.05 in OA) in the laparoscopic appendectomy group. Operative time was significantly shorter (54.9+/-14.7 in LA and 13.6+/-12.6 minutes in OA) in the open group. Total number of complications was less in the laparoscopic group; however, there was no statistically significant difference. The laparoscopic technique is a safe and clinically beneficial operative procedure. It provides certain advantages over open appendectomy, including short hospital stay, decreased requirement of postoperative analgesia, early food tolerance, and earlier return to normal activities. Where feasible, laparoscopy should be undertaken as the initial procedure of choice for most cases of suspected appendicitis.

Feasibility of right-sided total extraperitoneal procedure for inguinal hernia repair after appendectomy: a prospective cohort study

BackgroundTotally extraperitoneal (TEP) endoscopic hernia surgery is increasingly popular since it is associated with little postoperative pain and with early return to work. Previous appendectomy may preclude preperitoneal dissection in patients with right-sided hernias. The feasibility of TEP surgery in these patients was the subject of the present study.MethodsBetween January 2005 and February 2007 all consecutive patients undergoing TEP surgery were included in a prospective cohort study. The study group consisted of patients with right-sided and bilateral hernias. Operative times, conversions, complication rates, and return to daily activities were recorded. Patients were divided into two groups according to previous appendectomy.ResultsA total of 462 patients with right-sided hernias underwent TEP surgery: 421 patients without previous abdominal surgery (group 1) and 41 patients with previous appendectomy (group 2). The conversion rate was significantly higher in group 2: four patients (10%) were converted to open Lichtenstein repair versus five (1%) in group 1 (p = 0.005). However, we found no significant differences in complication rate, operative time, and return to daily activities.ConclusionsA right-sided (or bilateral) TEP procedure may be performed safely in patients after previous appendectomy. Despite a higher conversion rate, the vast majority of patients can be operated endoscopically.

Laparoscopy should be the approach of choice for acute appendicitis in the morbidly obese

Background The current study compared the outcome of morbidly obese patients undergoing laparoscopic versus open appendectomy. Methods We obtained data from the University HealthSystem Consortium (UHC) database on 1,943 morbidly obese patients who underwent appendectomy for acute or perforated appendicitis between 2002 and 2007. Results Compared to open appendectomy, laparoscopic appendectomy was associated with a shorter length of stay (3 vs 4 days) and a lower overall complication rate (9% vs 17%). Most notably, a lower rate of wound infection was noted (1% vs 3%). Within a subset analysis of morbidly obese patients who underwent appendectomy for perforated appendicitis, there was a higher overall complication rate (27% vs 18%) and cost ($16,600 vs $12,300) in the open appendectomy group. Conclusion In the morbidly obese, laparoscopic appendectomy performed for acute and perforated appendicitis is associated with a shorter length of stay and lower morbidity and costs. Laparoscopic appendectomy should be the procedure of choice for the treatment of acute appendicitis in the morbidly obese population.

Apendicitis aguda complicada. Abordaje abierto comparado con el laparoscópico

Although laparoscopy has become the standard approach in other procedures, this technique is not generally accepted for acute appendicitis, especially if it is complicated due reports on the increase in intra-abdominal abscesses. The purpose of this study was to evaluate the morbidity in a group of patients diagnosed with complicated apendicitis (gangrenous or perforated) who had undergone open or laparoscopic appendectomy. We prospectively studied 107 patients who had undergone appendectomy for complicated appendicitis over a two year period. Mean operation time, mean hospital stay and morbidity, such as wound infection and intra-abdominal abscess were evaluated. In the group with gangrenous appendicitis morbidity was significantly lower in laparoscopic appendectomy group (p = 0.014). Wound infection was significantly higher in the open appendectomy group (p = 0.041), and there were no significant differences in intra-abdominal abscesses (p = 0.471). In the perforated appendicitis group overall morbidity (p = 0.046) and wound infection (p = 0.004) was significantly higher in the open appendectomy group. There were no significant differences in intra-abdominal abscesses (p = 0.612). These results suggest that laparoscopic appendectomy for complicated appendicitis is a safe procedure that may prove to have significant clinical advantages over conventional surgery.

Three none: A new technique for open appendectomy. Prospective non-randomized comparative study

BACKGROUND: Appendectomy is a commonly performed operation and it has been constantly refined and updated several times over the past century. The aim of this study was to explore the safety and efficacy of a new operative technique for open appendectomy. METHODS: This is a comparative study of 240 patients who underwent open appendectomy between July 1998 and July 2003 at Alburaihy Hospital, Taiz, Yemen. Hundred and twenty patients underwent appendectomy by the 'three none technique' and same number by classical method. Age, sex, incision, and degree of inflammation match were ensured. Differences in hospital stay, duration of operation, postoperative analgesia, morbidity and mortality were evaluated. RESULTS: In the 'three none' group there were 58 males (48.3%) and 62 females (51.7%) while there were 51 males (42.5%) and 69 females (57.5%) for the classical appendectomy group. The outcome measures are significantly better for 'three none' technique. CONCLUSIONS: The 'three none' is a safe, easy and cost-effective technique for open appendectomy.

Anisakissimplex and Kudoa sp.: Evaluation of specific antibodies in appendectomized patients

High prevalence and intensity of infection with anisakid larvae has been reported in commercially important fish in Spain. Likewise, Kudoa-infected fish have lately been detected in both fresh and frozen fish. In the present study the possible relation between appendectomy and specific antibodies to these fish parasites was investigated. One hundred and sixty patients were enrolled in this study. They were divided into two groups of eighty patients each and matched for sex and age: Group 1 (appendectomized) and Group 2 (control group). Total immunoglobulins (Ig’s), IgG, IgM, IgA and IgE against Anisakis simplex or Kudoa sp. antigens were analysed by ELISA. The mean values of the specific antibodies were lower in the appendectomy group, although significant differences were not observed in the case of IgG, IgA and IgE anti- A. simplex and IgE anti- Kudoa sp. In summary, appendectomy significantly decreased serum specific immunoglobulin levels against these food borne parasite antigens. This decrease was detectable from three months to three years post-appendectomy. It is necessary to study the influence of the surgical removal of other important parts of the GALT on these anti-parasite humoral immune responses.

APPENDECTOMY;

. Objective: The purpose of this prospective study was to compare length of hospital stay, in hospital complications andoperative time between laparoscopic appendectomy (LA) and open appendectomy (OA). Setting: This prospective study was carried out atKing Khalid Hospital, Najran, Kingdom of Saudi Arabia over a period of 26 months from July 2002 to August 2004. Methods: Patients wererandomly divided into laparoscopic and open appendectomy groups and length of stay, operative time and in hospital complications were noted.Results:60 patients underwent laparoscopic appendectomy and 65 underwent open. Operating time was longer in laparoscopic group but lengthof stay was shorter in laparoscopic group. Wound infection was the common complication in both group but it was higher in patients whounderwent open appendectomy. Conclusion: Laparoscopic appendectomy can be performed with morbidity similar to open appendectomyand may actually have decreased wound infection rate.

Perforated Appendicitis: Urgency or Interval Surgery?

The purpose of this study was to report how conservative treatment with interval appendectomy (IA) of ruptured appendicitis with localized abscess or phlegmon affects the outcome of patients. From January 2001 to December 2005, 121 patients with ruptured appendicitis with localized abscess or phlegmon were treated in our hospital. 104 patients underwent appendectomy (Group A); 17 patients underwent antibiotic treatment with interval appendectomy (Group B). The clinical characteristics (age and sex), laboratory data, mean time to surgery, operative time, complications, hospital days and cost of hospitalization were recorded. The sex, age, white blood cell count (WBC), body temperature, operation time, length of stay after surgery, first flatus, oral feeding, passage of stools, cost and overall complications (including wound infection, wound disruption, intra-abdominal abscess and enterocutaneous fistula) were not significantly different between the two groups. However, the length of stay after diagnosis established of group B was significantly longer in group B than in group A. Conservative treatment with IA is a safe and effective method to treat perforated appendicitis with localized abscess and phlegmon, but the recovery time may be longer and also the hospital stay (since diagnosis established). Thus this method is not cost-saving.

Unsupervised Laparoscopic Appendicectomy by Surgical Trainees is Safe and Time-effective

Open appendicectomy is the traditional standard treatment for appendicitis. Laparoscopic appendicectomy is perceived as a procedure with greater potential for complications and longer operative times. This paper examines the hypothesis that unsupervised laparoscopic appendicectomy by surgical trainees is a safe and time-effective valid alternative. Medical records, operating theatre records and histopathology reports of all patients undergoing laparoscopic and open appendicectomy over a 15-month period in two hospitals within an area health service were retrospectively reviewed. Data were analysed to compare patient features, pathology findings, operative times, complications, readmissions and mortality between laparoscopic and open groups and between unsupervised surgical trainee operators versus consultant surgeon operators. A total of 143 laparoscopic and 222 open appendicectomies were reviewed. Unsupervised trainees performed 64% of the laparoscopic appendicectomies and 55% of the open appendicectomies. There were no significant differences in complication rates, readmissions, mortality and length of stay between laparoscopic and open appendicectomy groups or between trainee and consultant surgeon operators. Conversion rates (laparoscopic to open approach) were similar for trainees and consultants. Unsupervised senior surgical trainees did not take significantly longer to perform laparoscopic appendicectomy when compared to unsupervised trainee-performed open appendicectomy. Unsupervised laparoscopic appendicectomy by surgical trainees is safe and time-effective.

Laparoscopic versus open appendectomy in patients with chronic appendicitis

To compare the advantages and disadvantages of laparoscopic versus open appendectomy in patients with chronic appendicitis. Two hundred twenty- four patients were divided into laparoscopic group (n=98) and open appendectomy group (n=126) according to individual willing. Prospective non- randomized study was performed to compare the operative time, operative bleeding, hospitalization time, the discovery and management concerned in operation. Abdominal pain in these chronic appendicitis cases was followed up. The operative time was (54.8+/-21.8) min in open group and (51.8+/-18.0) min in laparoscopic group (t=0.80,P > 0.05). The operative bleeding was (18.6+/-23.3) ml in open group and (9.8+/-4.7) ml in laparoscopic group (t=3.13, P < 0.05). The hospitalization time was (8.9+/-5.3) d in open group and (6.8+/-3.0) d in laparoscopic group (t=2.66,P < 0.05). Twenty- five cases had abdominal adhesion in laparoscopic group, including 9 cases of adhesion around appendix, 6 cases of adhesion between ileocecum and anterior or lateral abdominal wall, 4 cases of adhesion between epiploon and abdominal wall or intestines, 6 cases of adhesion around colon and others. All adhesion had been dissected. Fourteen cases adhesion around appendix had been discovered in 126 cases of open group and dissected (chi(2) =7.95,P < 0.05). In follow- up research, 24 cases still had chronic abdominal pain in 98 case of open group, and 9 cases had chronic abdominal pain in 87 of laparoscopic group, the difference was significant (chi(2)=6.29,P < 0.05). The laparoscopic appendectomy possesses more advantages in treating chronic appendicitis and can decrease the incidence of chronic abdominal pain after operation.

Role of Interval Appendectomy in the Management of Complicated Appendicitis in Children

The aim of this study was to ascertain the optimal treatment for children with complicated appendicitis. We reviewed an inception cohort of children with documented complicated appendicitis to develop criteria for interval appendectomy. We compared the outcomes of two treatments: immediate operation and interval appendectomy. Children with complicated appendicitis were separated into two groups. Group 1 patients had had symptoms of complicated appendicitis for less than 72 hours or appeared toxic. Group 2 patients had had symptoms of complicated appendicitis for longer than 72 hours and did not appear toxic. Group 1 underwent immediate operation treated by criteria previously published. Group 2 patients were treated in hospital with triple antibiotics until they were afebrile, had normal white blood cell counts, tolerated an oral diet, and had adequate pain control. They were discharged on oral metronidazole or metronidazole plus Bactrim for 6 weeks and then underwent interval appendectomy. A total of 86 children had complicated appendicitis; 59 were operated on immediately, and 27 underwent an interval appendectomy. Complications included one wound infection and two intraabdominal abscesses (all in group 1). There was one death (group 1). The length of stay for the immediate operation group was 4.9 +/- 1.7 days; the initial-admission length of stay for the interval appendectomy group was 4.1 +/- 1.0 days with a subsequent postoperative stay of 0.9 +/- 0.8 days. One patient in the interval appendectomy group was treated off protocol. Treating selected children with interval appendectomy led to a decrease in complications and a shorter length of stay in this limited population. Interval appendectomy is a safe, cost-effective, useful adjunct treatment for children with complicated appendicitis.

Preoperative and postoperative levels of interleukin-6 in patients with acute appendicitis: comparison between open and laparoscopic appendectomy

Cytokine interleukin-6 (IL-6) is an early marker of systemic inflammatory response and tissue damage. This study aimed to evaluate the levels of IL-6 after open and laparoscopic appendectomy to compare the degree of surgical stress associated with these procedures. The levels of IL-6 were measured pre- and postoperatively in the plasma of 37 consecutive patients with a diagnosis of acute appendicitis. After preoperative randomization, 22 patients underwent open appendectomy, and 15 patients underwent laparoscopic appendectomy. The preoperative concentrations of IL-6 were 7.2 +/- 5.6 pg/ml in the open appendectomy group, as compared with 12.1 +/- 9.7 pg/ml in the laparoscopic appendectomy group (p < 0.05). The postoperative levels were 16.9 +/- 15.7 and 23.2 +/- 19.4 pg/ml, respectively. The mean postoperative to preoperative ratio of IL-6 was slightly higher for open (2.7 +/- 2.4) than for laparoscopic (2.3 +/- 1.6) appendectomy, but the difference did not reach statistical significance. The operative stress in open as compared with laparoscopic appendectomy is not reflected by circulating levels of IL-6.

Laparoscopic versus open appendectomy in children with uncomplicated and complicated appendicitis

Purpose To address whether laparoscopic appendectomy could be an alternative to conventional open appendectomy in children with complicated appendicitis as well as uncomplicated appendicitis, a retrospective study comparing laparoscopic and open appendectomies was performed. Methods One hundred patients who were treated by immediate appendectomy, either laparoscopically or by the open method, between May 2000 and August 2003 were included in the study. There were 53 patients in the laparoscopic appendectomy group and 47 patients in the open appendectomy group. Results The operating time was significantly longer for laparoscopic appendectomy than for open appendectomy ( P < .001). The length of hospital stay was significantly shorter in laparoscopic appendectomy in patients with uncomplicated appendicitis ( P = .001). Thirteen of the 100 patients (13.0%) had 15 postoperative complications including wound infection (n = 8), intraabdominal abscess (n = 4), stitch abscess (n = 2), and small bowel obstruction (n = 1). In both uncomplicated and complicated appendicitis, there was no significant difference between laparoscopic and open appendectomies in the complication rates, and the incidences of each complication did not differ between the procedures. Among the 14 patients with generalized peritonitis, postoperative complications were seen in 5 patients (35.7%). Although the presence of generalized peritonitis was associated significantly with postoperative complications ( P = .017), there was no significant association between the procedure and complications. Overall treatment costs were increased by 26.0% in laparoscopic appendectomy. Conclusions Laparoscopic appendectomy should remain an option in children with uncomplicated and complicated appendicitis, and when laparoscopy is selected, consideration of the advantages and disadvantages of the procedure is essential.

ROLE OF APPENDECTOMY IN THE CLINICAL COURSE OF CROHNʼS DISEASE

Purpose: History of appendectomy is associated with an increased risk of Crohn's disease (CD). Recently, the appendix has been noted for its significant role in mucosal immune function. The impact of prior appendectomy among CD patients on disease severity has not been studied. Therefore, we are evaluating this relationship. Methods: We reviewed a cohort of 1500 patients with Inflammatory Bowel Disease and identified 40 patients with CD who underwent appendectomy prior to being diagnosed with CD. These patients were compared to an age and gender matched control group of 40 CD patients without a history of appendectomy. Comparisons were made on demographic characteristics as well as on disease location, behavior, and severity (CD related hospitalizations, surgeries, and relapses) using either parametric or nonparametric tests accordingly. Results: Each group was comprised of 30% males and 70% females with CD. The distribution of professional status and medical insurance were similar (p = 0.78, p = 0.63, respectively). There was no difference in age of symptom onset (34 vs. 33 years, p = 0.58) and lag time to diagnosis (26 vs. 13 months, p = 0.15) in CD patients with and without previous appendectomy. Since the duration of patient follow-up between the appendectomy and control group was significantly different (152 (6–438) vs. 217 (8–680) months, p = 0.03), the number of hospitalizations, surgeries, and relapses were calculated as rates (number of events/follow up time) to correct for this difference. Table 1 shows the results on rate of hospitalizations, surgeries, and relapses between groups. Disease location (p = 0.57) and behavior (p = 0.37) did not differ between groups. However, there was a trend for the control group to have disease localized to the colon (p = 0.057).Table 1: Disease SeverityConclusions: The appendectomy group had significantly more CD related hospitalizations and surgeries. Based on these preliminary data, it appears that the appendix may have an immune modulating effect in the pathogenesis of CD.