Should the 'normal' appendix be removed at operation for appendicitis?

A prospective study was conducted over a 6-month period to assess the ability of the surgeon to determine the presence or absence of acute inflammation of the appendix at operation for acute appendicitis. Over the study period 175 appendices were removed of which 131 (75%) were acutely inflamed histologically. The surgeon's assessment as to the presence of acute inflammation was correct in 120 out of 132 cases, a positive predictive value of 91%. When the surgeon assessed the appendix as being non-inflamed he was wrong in 11 of 43 cases, a false reassurance rate of 26%. The increasing use of laparoscopy in the assessment and treatment of patients with the clinical features of appendicitis should not alter the practice of removing the appendix when it appears macroscopically normal. To do so may result in a number of patients requiring a second operation to remove the appendix in the early postoperative period.