KARACHI, June 24: The practice of removing the appendix of those patients who do not need surgery is quite prevalent in private hospitals.

Senior doctors told Dawn on Monday that in some private hospitals surgeons were directed by the administration to carry out as many surgeries as possible. “At times, junior doctors are given a dressing-down for not carrying out appendectomy of those patients who complained of acute pain on the lower right side of the abdomen.”

They added that at most hospitals the rates for appendectomy ranged between Rs15,000 and Rs25,000. “It is no wonder, then, that surgeons are asked to carry out as many appendectomies as they could.”

The secretary-general of the Pakistan Medical Association, Dr Shershah Syed, admitted that some surgeons carried out appendectomy needlessly. He added that the responsibility for checking such professional misconduct rested with the Pakistan Medical and Dental Council.

Dr Mohammad Saeed Quraishy, surgeon at Lyari General Hospital, also conceded that some doctors indulged in this reprehensible malpractice of removing the appendix of those patients who did not need appendectomy. He added that because the appendix was a vestigial organ its removal did not affect a patient.

“According to internationally acceptable standards, 25 cases of appendectomy out of 100 could be that of those patients who do not need removal of the appendix. But with the introduction of advanced technology, such as laproscopy, high-quality ultrasound and spiral CT scan, the incidence of appendectomy has been reduced all over the world. Besides, it is at times difficult to find out for sure whether the pain on the lower right side of the abdomen is inflamed appendicitis or not.”

He said the patients should insist upon receiving biopsy reports which would enable them to find out if the appendectomy had been carried out unnecessarily or not.

A biopsy is the examination of liquids or tissue taken from the body of somebody who is ill in order to find out more about their disease.

Doctors explain that appendicitis is inflammation of the appendix, a small pouch attached to the cecum, the beginning of the colon, on the lower right side of the abdomen. The appendix is not necessary for life, but it can become diseased. If untreated, an inflamed appendix can burst, causing infection and even death. Appendicitis can affect people at any age. It is most common in people ages 10 to 30.

The cause of appendicitis is usually unknown. It may occur after a viral infection in the digestive tract or when the opening connecting the large intestine and appendix is blocked. The inflammation can cause infection, a blood clot, or rupture of the appendix.

Dr Arshad Siddiqui, resident medical officer at the surgical unit 1 of the Civil Hospital Karachi, says that the symptoms include pain in the right side of the abdomen, nausea, vomiting, constipation, diarrhoea, inability to pass gas, low fever that begins after other symptoms, abdominal swelling, anorexia.

“The pain usually begins near the navel and moves down and to the right. The pain becomes worse when moving, taking deep breaths, coughing, sneezing, and being touched in the area. Not everyone has all the symptoms. People with symptoms of appendicitis should not take laxatives or enemas to relieve constipation because these medicines could cause the appendix to burst. Pain medicine can mask symptoms that the doctor needs to know about, so it should not be used before consulting a doctor when appendicitis is suspected.”

He points out that the doctor bases an appendicitis diagnosis on symptoms, a physical exam, blood tests to check for signs of infection such as a high white blood cell count, and urine tests to rule out a urinary tract infection. Usually doctors use CT scan or ultrasound to see whether the appendix looks inflamed (which means that the appendix is more than six millimetre thick). Early, mild appendicitis may sometimes be cured with antibiotics. More serious cases are treated with surgery to remove the appendix. Doctors may use laproscopic surgery for appendectomy. This technique involves making several tiny cuts in the abdomen and inserting a miniature camera and surgical instruments. The surgeon then removes the appendix with the instruments, so there is usually no need to make a large incision in the abdomen.