Appendicectomy in ulcerative colitis: a narrative review of epidemiology, pathophysiology, and emerging therapeutic implications

Abstract Evidence from multiple studies shows that the appendix may play a significant role in the pathogenesis of ulcerative colitis (UC). These findings have sparked interest in the possibility of appendicectomy as a potential adjunctive strategy in UC. This narrative review was conducted by synthesizing data from meta-analyses, immunological research, surgical case studies, population data reports, and prospective trials published since 2000. The evidence was appraised with a focus on appendicectomy and its clinical outcomes in UC, risks and limitations, as well as possible future directions. Observational studies show a reduced risk of colectomy and UC-related hospital admissions when appendicectomy is performed before UC diagnosis. On the other hand, appendicectomy post UC diagnosis in the presence of appendiceal inflammation has shown increased risk of colectomy. But if an appendicectomy is performed in the absence of inflammation, it might not correlate to the risk or reduce the risk of relapse and complications. Evidence also shows that patients with refractory UC may benefit from appendicectomy and may show longer periods of remission. However, some studies show appendicectomy might increase the colorectal cancer risk due to alterations in immunity and microbiota. While medical management remains the first line, appendicectomy may act as an adjunct surgical option in carefully selected cases before escalating to a colectomy. Large multicenter studies and randomized clinical trials are required to identify strategies for patient selection, potential complications, durability of response, and long-term outcomes.