Text 1 History of appendix surgery

The first report of an appendectomy (also called appendicectomy) came from Amyan, a surgeon of
the English army. Amyan performed an appendectomy in 1735 without anaesthesia to remove a
perforated appendix. Reginald H. Fitz, an anatomopathologist at Harvard who advocated early
surgical intervention, first described appendicitis in 1886. Because he was not a surgeon, his
advice was ignored for a time.

Then, at the end of the 19th century, the English surgeon H. Hancock successfully performed the
first appendectomy in a patient with acute appendicitis. Some years after this, the American C.
McBurney published a series of reports that constituted the basis of the subsequent diagnostic and
therapeutic management of acute appendicitis.

Appendectomy, either open or laparoscopic, currently remains the treatment of non-complicated

appendicitis.

Text 2 Anatomy of the appendix

The appendix is a wormlike extension of the caecum and, for this reason, has been called the
vermiform appendix. The average length of the appendix is 8-10 cm (ranging from 2-20 cm). The
appendix appears during the fifth month of gestation, and several lymphoid follicles are scattered
in its mucosa. Such follicles increase in number when individuals are aged 8-20 years

Text 3 Statistics

The incidence of acute appendicitis is around 7% of the population in the United States and in
European countries. In Asian and African countries, the incidence of acute appendicitis is probably
lower because of the dietary habits of the inhabitants of these geographic areas.

In the last few years, a decrease in frequency of appendicitis in Western countries has been
reported, which may be related to changes in dietary fibre intake. In fact, the higher incidence of
appendicitis is believed to be related to poor fibre intake in such countries.

Persons of any age may be affected, with the highest incidence occurring during the second and
third decades of life. Rare cases of neonatal and prenatal appendicitis have been reported.

Appendicitis occurs more frequently in males than in females, with a male-to-female ratio of 1.7:1.
Text 4 Prospective randomized comparison of open versus
laparoscopic appendectomy in men.

Department of Surgery, Flinders Medical Center, South Australia, Australia.

Abstract
A prospective, randomized trial was performed to compare open appendectomy with laparoscopic

appendectomy in men with a clinical diagnosis of acute appendicitis. Sixty-four patients with a median

age of 25 years (range 18-84 years) were randomized to open appendectomy (n = 31) or laparoscopic

(n = 33) appendectomy. Of the 64 men, 56 (87.5%) had appendicitis (27 open, 29 laparoscopic

procedures). The mean operating times were 50.6 +/- 3.7 minutes (+/- SEM) for open and 58.9 +/- 4.0

minutes for laparoscopic appendectomy (p = 0.13). Five (15%) patients randomized to laparoscopic

appendectomy had an open operation. The mean postoperative hospital stay was significantly longer for

open appendectomy (3.8 +/- 0.4 days) than for laparoscopic appendectomy (2.9 +/- 0.3 days) (t = 2.

05,df = 62,p = 0.045). The complication rate after open appendectomy (25.8%) was higher than after

laparoscopic appendectomy (12.1%). There was a single postoperative death due to a pulmonary

embolus in the laparoscopic group and a single death due to cardiac and renal failure in the open group.

The mean time to return to normal activities was significantly longer following open appendectomy (19.7

+/- 2.4 days) than after laparoscopic appendectomy (10.4 +/- 0.9 days), (t = 3.75,df = 49,p = 0.001). In

conclusion, laparoscopic appendectomy in men has significant advantages in terms of a more rapid

recovery compared to open appendectomy. There were no significant disadvantages of laparoscopic

appendectomy compared to open appendectomy.

Reading – Subtest A Level III (four texts)

Appendicitis

Complete the following summary using the

information in the texts provided. You do
not need to read each text from beginning to
end to complete the task. You should scan
the texts to find the information you need.
Gaps may require 1, 2 or 3 words. You
should write your answers next to the
appropriate number in the right hand
column. Use correct grammar and spelling –
marks will be lost if there is incorrect
spelling. Please write legibly.

Summary Task

10

11

12

13

14
The vermiform (1) is a worm-like extension of the (2) , and is on average 8 –
10 cm in (3). The presence of lymphoid (4) in the (5) is a characteristic
feature, and more of these develop during later (6) and adolescence.

The appendix is subject to inflammatory change, and (7) is common in many

countries. In the USA, approximately (8) of the population suffer appendicitis
during their life, and the statistics are (9) in Europe. However, (10) countries
have a lower incidence, probably due to a higher (11) content in their (12).
The disease is (13) common in females than males, with a female to male
ratio of (14).

(à next page)

15

16

17

18

19

20

21

22

23

24

25

26

27

28

The mainstay of treatment is (15) (also known as appendicectomy) and it was

(16) performed by an English Army doctor in (17). However, it was (18) until
the end of the (19) century that it became an accepted treatment. Some years
later, the work of the American (20) finally established the principles of the
(21) and treatment of appendicitis.

Nowadays, there are (22) types of operations that can be done – (23) or
laparoscopic appendectomy. Either procedure is suitable for most patients,
with a recent study at (24), South Australia, showing only a slightly (25)
operating time with laparoscopy, but significantly (26) time in hospital.
Furthermore, the time taken to return to (27) after open operation was almost
20 days, compared to only slightly (28) days in the laparoscopic group.

Summary text – Appendicitis

The vermiform appendix is a worm-like extension of the caecum, and is on

average 8 – 10 cm in length. The presence of lymphoid follicles in the
mucosa is a characteristic feature, and more of these develop during later
childhood and adolescence.

The appendix is subject to inflammatory change, and appendicitis is

common in many countries. In the USA, approximately 7% of the population
suffer appendicitis during their life, and the statistics are similar / the same in
Europe. However, African and Asian countries have a lower incidence,
probably due to a higher fibre content in their diet / diets / food. The disease
is less common in females than males, with a female to male ratio of 1/1.7.
The mainstay of treatment is appendectomy (also known as
appendicectomy) and it was first performed by an English Army doctor in
1735. However, it was not until the end of the 19th century that it became an
accepted treatment. Some years later, the work of the American C. McBurney
finally established the principles of the diagnosis and treatment of
appendicitis.

Nowadays, there are 2 types of operations that can be done – open or

laparoscopic appendectomy. Either procedure is suitable for most patients,
with a recent study at Flinders Medical Centre, South Australia, showing
only a slightly longer operating time with laparoscopy, but significantly
shorter time in hospital. Furthermore, the time taken to return to normal
activities after open operation was almost 20 days, compared to only slightly
more than 10 days in the laparoscopic group.