Management of the 'normal' appendix during surgery for right fossa syndrome: proposed clinical algorithm

The management of the normal appearing appendix during laparoscopy for right fossa syndrome remains a matter of debate when no other cause is found. Recent data suggest that the appendix modulates both the normal brain-gut axis and the pathophysiology of inflammatory bowel disease by neuro-immunological pathways. Recurrence of symptoms caused by acute appendicitis is uncommon when the appendix is left in place. The decision to remove a normal appendix should therefore not be taken lightly, but after consideration of the patient's age, medical history and expectations as well as the timing and specificity of the presenting symptoms. An overview of the relevant literature is provided with an algorithm to aid in clinical decision making.