ALL OF OUR ORGANS AND BODY PARTS ARE VITAL
THERE ARE NO UNNECESASRY BODY PARTS. AN ORGAN SPARING APPROACH SOULD BE THE NEW NORMAL FOR ANY SURGERY.
“The surgical cycle in woman : Appendix removed, right kidney hooked up, gallbladder taken out, gastroenterostomy, clean sweep of uterus and adnexa.” - Sir Dr. William Osler (1849 – 1919)
Many of us, growing up had our tonsils and adenoids removed and/or our appendix taken out. We were given utmost assurances that they were vestigial remnant organs left from human evolution. And that they cause more harm than good and that they should be removed. Even today, these procedures are still on the list of the most popular surgeries, with the addition of gallbladder removal (cholecystectomy) and after childbearing age, the removal of the uterus (hysterectomy).
However, ongoing clinical and scientific studies have shown that all our organs and body parts are vital and essential, and that they play important roles in our health and wellbeing.
Let’s look at tonsils and adenoids. In an important Danish study, 1.2 million children after having their tonsil and/or adenoids removed were followed up with for 10 years. It clearly showed that these children, compared to a control group, have had two–to–three times more upper respiratory infections (URI), asthma, middle ear and sinus infections, and allergies. The purpose of the surgery was supposed to prevent these conditions from happening in the first place.
When we look at the appendix and appendectomies, we clearly see that the appendix is not a vestigial organ but an important immunologic organ. Studies of the animal kingdom have shown that all mammalians have an appendix. The appendix is closely related to lymphoid organs and is a part of our immune system. Additionally, the appendix is a safe harbor for colonic microbiome bacterial population. If for any reason the bacterial population is diminished, they are easily replaced by appendix housed bacterial population.
A dangerous and pathogenic bacteria called Clostridium difficile lives among the colonic microbiome population but kept in check by them. This bacteria could cause a severe form of infectious colitis called, “pseudomembranous colitis” when the colonic bacterial population is diminished for any reason or killed by taking oral antibiotics for a long period of time. Then C. diff population explodes and causes severe colitis. Clinical studies have shown half that of the appendectomy patients have two and a half times more prone developing C. diff Colitis.
Appendectomies has also been associated with increased risk of other diseases, like kidney failure in diabetics, lupus in women, inflammatory bowel diseases like UC, and Crohn’s disease and other types of auto-immune diseases.
Because of the dangerous consequences of appendectomies, a new trend of “organ – preserving therapy” by several clinical investigators. A recent multicenter randomized, clinical study (JAMA 2020) of uncomplicated 423 acute appendicitis cases were treated with antibiotics successfully and 73 % of them didn’t require surgery.
Today, there is also an endoscopic intervention and therapy for uncomplicated acute appendicitis. This is a kind of colonoscopic incision and drainage of an abscess. The appendiceal orifice is cannulated with colonoscopy and the appendicolith is removed by a balloon catheter and appendiceal lumen is irrigated (GIE, 2020). The success rate of this kind of therapy, in expert hands, has been as high as 97%.
Antibiotic treatments have also successful in uncomplicated acute diverticulitis, avoiding colostomy and bowel resections.
Also, the removal of the uterus (hysterectomy) could be avoided for fibroid tumors by available interventional vascular or ablative methods.
May be the same thing could be done for asymptomatic gallstone cases, only the stones removed, gallbladder left in place, and the infection treated with antibiotics.
The gallbladder is not on only a depo organ for the bile, which is produced in the liver in a continuous fashion and sent to the gallbladder via bile ducts to be modified, concentrated and only emptied at once, in a timely manner, when meals enter from the stomach into the small bowel (duodenum) for the digestion of lipid and fatty meals. After a cholecystectomy, the bile continuously, with a small amount and a weak concentration, flows into duodenum. Bile is an irritant for the small bowel lining, therefore after gallbladder surgery, diarrhea together with maldigestion of fatty meals are very common.
There is lots of uncertainty in medicine and information and medical knowledge are continuously evolving. I believe this is time is right time for an important paradigm shift for “organ-sparing” in any kind of surgery.
