Opponents to incidental appendicectomy consider that transaction of fecal containing material violates sound surgical principles. The procedure increases the operative time and the morbidity. There is an increased chance of wound infection in patients undergoing appendicectomy as an incidental additional procedure.

While this controversy continues, surgeons have performed reconstructive procedures using the vermiform appendix. Chooramani Gopal, et al.(2) have utilized the vascularized appendiceal graft to reconstruct the biliary tract after excision of the choledochal cyst. Gupta and Rohtagi(3) successfully used an anti-peristaltic appendiceal conduit for reconstruction in biliary atresia. Sheldon et al.(4) have used appendix for urinary diversion in cases with urinary anomalies. Aggarwal, et al.(5) used the pedicled appendiceal graft for replacing the urethra in recurrent urethral stricture.

I have devised a procedure to create a catheterizable non-refluxing gastrostomy for long term feeding in children with various anomalies. It is applicable especially in cases when the appendix is available in the left upper abdomen in patients with malrotation. The appendix is mobilized on the vascular pedicle and transplanted as a conduit between stomach and skin surface. It is proposed not to perform appendicectomy as a part of classical Ladd’s procedure done for malrotation. Instead the appendix should be left in place indicating the same on the patient’s records for further reference and avoiding diagnostic confusion because of abnormal position of organ.

In view of the vast number of reconstructive procedures described, it is prudent not to sacrifice the appendix during an unrelated surgical procedure as the patients may require it in future.

Anup Mohta,
Associate Professor,
Department of Surgery,
University College of Medical Sciences and GTB Hospital,
Delhi 110 095, India.
E-mail: [email protected]