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PubMed1994

Indications for paediatric tonsillectomy GP versus Consultant perspective.

Tonsillectomy is a commonly performed operation in children. Although the justification for this procedure has been debatable in the past, more rigorous criteria in defining the need for tonsillectomies are becoming established. The role of the primary care physician in the management of tonsillar disease in children is important as the decision to refer a child for tonsillectomy is made by the general practitioner. A questionnaire survey of 400 general practitioners (GPs) and 31 consultant ENT surgeons was carried out to establish the important criteria used in deciding the need for paediatric tonsillectomy. We found that in general there was a good correlation between GP and Consultant indications for tonsillectomy. However there were two important areas of difference, while most of the GPs felt that recurrent ear infections and 'glue ear' were important indications for tonsillectomy, Consultants did not. Therefore we must be aware of the current recommendations for tonsillectomy and inform present and future GPs.

Attitude of Health Personnel↗

PubMed2006

Is unilateral tonsillar enlargement alone an indication for tonsillectomy?

INTRODUCTION: Unilateral tonsillar enlargement is often seen in the out-patient setting. Frequently, these patients are listed for tonsillectomy for the purpose of ruling out malignant histology. This study aims to determine the necessity for tonsillectomy. METHOD: This retrospective case-note review looks at all the tonsillectomies performed for histological examination at our institution over a five year period, and analyses the histological findings in those with unilateral tonsillar enlargement (UTE) alone, and those with UTE with other clinical features (history of chronic pain, dysphagia, the presence of tonsillar or peritonsillar mucosal abnormality, those with cervical lymphadenopathy). All patients who underwent tonsillectomy for the purpose of histological examination from 1 June 1998 to 30 May 2003 were identified and their notes reviewed. Exclusion criteria included cases where there were no pre-operative out-patient notes, those patients where the specimens had been sent from other hospitals, those patients who had malignancy already diagnosed, and those cases where tonsillectomy had been performed by other surgical specialties (e.g. maxillofacial, plastics). There were 1475 tonsillectomies, of which 181 performed over this period were sent for histological analysis. After excluding those patients that did not meet our criteria, we were left with 53 patients who had UTE. The primary outcome measure was the rate of malignancy in the two groups. RESULTS: Of these, 33 had UTE alone, 20 had associated clinical features. In the former group, none of the patients were found to have malignancy. In the latter, nine (45 per cent) had a malignancy. Fisher's exact test was used to test for differences between the UTE alone group versus the UTE plus other features group (p<0.001). DISCUSSION: The prevalence of malignancy in tonsils which exhibit asymmetry with no other clinical features is very low; in our study it was zero. However, other studies have found a small percentage representing underlying malignancy. In view of this, we feel that a 'watch and wait' policy is initially more appropriate, and if symptoms or signs are progressive, tonsillectomy should then be advised.

Adult↗

PubMed2006

'Group and save' for paediatric tonsillectomy: is it required routinely?

OBJECTIVES: The aims of this study were: (1) to establish current UK practice with respect to 'group and save' of serum for paediatric tonsillectomy; and (2) to determine the need to group and save serum prior to routine paediatric tonsillectomy. METHODS: Members of the British Association of Otorhinolaryngologists-Head and Neck Surgeons were surveyed by e-mail. A prospective study (November 1999 to August 2002) of all children undergoing tonsillectomy or adenotonsillectomy was undertaken. Outcome measures included reactionary and secondary post-tonsillectomy haemorrhage rates, blood transfusion requirements and 'return to theatre' rates. RESULTS: We surveyed 464 association members. The response rate was 52 per cent (n=242). Twenty-five respondents (10.3 per cent) indicated that they undertook group and save prior to tonsillectomy or adenotonsillectomy in children. Two hundred and seventeen (89.7 per cent) indicated that they did not. Of those who did group and save for children, 20 respondents (80 per cent) did so routinely. The remaining five respondents (20 per cent) did so only for children weighing less than 15 kg (n=4) or less than 10 kg (n=1). During the study period, 325 children underwent tonsillectomy or adenotonsillectomy. The reactionary haemorrhage rate was 0.6 per cent (n=2) and the secondary haemorrhage rate 5.5 per cent (n=18). The two cases of reactionary haemorrhage were returned to theatre immediately for control of haemostasis. All secondary haemorrhages were managed conservatively. No child required blood transfusion during the study period. CONCLUSION: Routine group and save of serum for children undergoing elective tonsillectomy or adenotonsillectomy seems unnecessary. We recommend that it be undertaken only in special circumstances.

Adenoidectomy↗

PubMed2003

The admission of patients with peri-tonsillar abscess to a general ENT ward and its influence on secondary post-tonsillectomy haemorrhage.

Patients with peri-tonsillar abscess require hospitalization. The aim of this prospective study was to determine whether the admission of patients with peri-tonsillar abscess to the same ward as those undergoing tonsillectomy influences the incidence of secondary post-tonsillectomy haemorrhage. We included all adult patients undergoing in-patient tonsillectomy (n = 183) and all patients with proven peri-tonsillar abscess (n = 46) over a 1-year period. Both patient groups were nursed in the same general otolaryngology ward. The operation dates of those patients who developed secondary post-tonsillectomy haemorrhage were matched to the dates when patients with peri-tonsillar abscess were admitted. Out of the 71 patients who had tonsillectomy on days when patients with peri-tonsillar abscess were admitted, 10 developed secondary haemorrhage. Out of the 112 patients who had tonsillectomy on days when no one in the ward had peri-tonsillar abscess, 16 developed secondary haemorrhage. No difference was demonstrated (chi2 = 0.0014, P > 0.05). In this study, admission of patients with peri-tonsillar abscess to a general otolaryngology ward does not influence the incidence of secondary post-tonsillectomy haemorrhage in patients undergoing elective surgery.

Adolescent↗

PubMed2004

Clinical and immunohistochemical study of immunoglobulin A nephropathy (IgAN) before and after tonsillectomy.

Tonsillectomy often improves clinical features in immunoglobulin A nephropathy (IgAN), however, the mechanisms mediating clinical modifications are unclear. In the present study, we examined the immunohistological alterations in biopsy specimens obtained from IgAN patients before and after tonsillectomy. We investigated eight IgAN patients who underwent repeated renal biopsy in the present study. Immunohistochemistry for alpha-smooth muscle actin (alpha-SMA), CD68 and proliferating cell nuclear antigen (PCNA) were performed and histological findings were compared before and after tonsillectomy. None of the patients were treated with steroids or immunosuppressive drugs before second renal biopsy. The expression of alpha-SMA and the number of CD68 positive cells were significantly decreased in IgAN patients with improvement of proteinuria and hematuria after tonsillectomy. The degree of mesangial cell proliferation, expansion of mesangial area and the number of PCNA positive cells were not changed after tonsillectomy. These results suggest that the reduced number of activated mesangial cells and macrophages may be involved in the improvement of hematuria after tonsillectomy. They also suggest that tonsillectomy may improve proteinuria and hematuria in some patients with IgAN through reduction of mesangial cell activation and macrophage infiltration.

Actins↗

PubMed1998

Efficacy of tonsillectomy for recurrent throat infection in adults.

OBJECTIVE/HYPOTHESIS: Sore throats result in health care visits, use of oral antibiotics, and days off work or school for many patients who do not meet American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for tonsillectomy. We sought to determine whether tonsillectomy would benefit this group. STUDY DESIGN: Retrospective analysis of the medical records of all patients aged 16 years or older who had tonsillectomy at our institution between 1988 and 1993. METHODS: Number of clinic visits, number of throat cultures positive for streptococci, and number of prescriptions for oral antibiotics recorded for 147 patients during the 2-year periods before and after tonsillectomy were tabulated. Statistical comparisons were made using the Student's t test. Mean number of clinic visits and oral antibiotics prescribed for throat infection before tonsillectomy were significantly higher than after tonsillectomy. RESULTS: Patients who had throat cultures positive for streptococci had more preoperative clinic visits and use of oral antibiotics than patients whose throat cultures were not positive for streptococci. When surveyed by telephone, most (>87%) of the respondents reported that they had fewer and less severe sore throats, required fewer days off work or school, and would recommend the procedure. CONCLUSIONS: Our results suggest that early tonsillectomy in patients with recurrent throat infection may result in improved patient satisfaction, better health, and improved utilization of medical resources.

Adolescent↗

PubMed2001

Evaluation of the utility and cost-effectiveness of obtaining histopathologic diagnosis on all routine tonsillectomy specimens.

OBJECTIVES: To evaluate the use and necessity of obtaining histopathology on patients undergoing tonsillectomy, and to provide indications and guidelines for requesting histopathology on tonsillectomy patients. STUDY DESIGN: At the University of Mississippi Medical Center, we have been routinely obtaining histopathologic diagnoses on every patient undergoing tonsillectomy or tonsillectomy and adenoidectomy. Specimens are separated into left and right tonsils and adenoids. This study was designed at our tertiary care academic center to evaluate the necessity for obtaining histopathologic diagnosis on each of these patients. METHODS: A retrospective review of histopathologic reports on all patients in both pediatric and adult age groups undergoing tonsillectomy or tonsillectomy and adenoidectomy between January 1994 and December 1999 was performed. RESULTS: A total of 2438 reports were reviewed. There were 2099 in the pediatric age group and 339 were adults. None of the children had an unusual histopathology finding other than lymphoid hyperplasia. Of the 339 adults, 34 had squamous cell carcinoma and 6 had lymphoma; however, these findings were suspected preoperatively by history and clinical manifestations. CONCLUSIONS: The general practice guidelines mandate obtaining histopathologic diagnoses on most of the tissues received. Based on our review, histopathology of tonsillectomy and/or adenoidectomy may not be necessary, especially in children. In this era of cutting excess costs of health care dollars, waving histopathology in these cases may have major implications without compromising delivery of quality care.

Adenoidectomy↗

PubMed2001

Bipolar scissors versus cold dissection tonsillectomy: a prospective, randomized, multi-unit study.

OBJECTIVE: To evaluate bipolar scissors tonsillectomy by comparing it with traditional cold dissection tonsillectomy. STUDY DESIGN: A prospective, randomized, multi-unit study. SETTINGS: Belfast City Hospital, Royal Victoria Hospital Belfast, and Ulster Hospital Dundonald. PATIENTS: Two hundred consecutive patients undergoing tonsillectomy for recurrent or chronic tonsillitis between March 2000 and September 2000. OUTCOME MEASURES: (1) Intraoperative bleeding, (2) operative time, (3) postoperative pain, and (4) complication rates, including primary and secondary hemorrhage. RESULTS: Seventeen patients were excluded from the study for various reasons. The mean age of the study population was 22 years (range, 10-54 y). Seventy-two percent of patients were female. Twenty-seven percent of patients were children aged 16 years or under. Median intraoperative blood loss was 5 mL for bipolar scissors tonsillectomy and 115 mL for cold dissection tonsillectomy (P < .001). The mean operative time was 13 minutes for bipolar scissors tonsillectomy compared with 20 minutes for the cold dissection method (P < .001). There was no statistically significant difference in the pain scores between the two methods (independent samples t = 1.35; P > .05). The overall primary hemorrhage rate was 2.1%, whereas the overall secondary hemorrhage rate was 16.9%. The hospital readmission rate was 10.3%. The primary and secondary hemorrhage rates were unaffected by the surgical method. CONCLUSIONS: Bipolar scissors tonsillectomy is a safe technique with a similar morbidity to the cold dissection method. Its use is associated with a significant decrease in both surgical time and blood loss compared with the cold dissection method.

Adolescent↗

PubMed2006

Efficacy of tonsillectomy in treatment of recurrent group A beta-hemolytic streptococcal pharyngitis.

OBJECTIVE: The objective of this study was to determine whether children with tonsillectomies experienced fewer recurrent group A beta-hemolytic streptococcal (GABHS) infections after surgery compared with children who did not receive tonsillectomies. STUDY DESIGN/METHODS: The authors conducted a retrospective cohort study of 290 children 4 to <16 years who experienced three or more episodes of group A beta-hemolytic streptococcal pharyngitis at least 1 month apart in 12 months. RESULTS: Children without tonsillectomy were 3.1 times (95% confidence interval, 1.9-4.9; P < .001) more likely to develop a subsequent group A beta-hemolytic streptococcal pharyngitis infection during follow up than children who underwent tonsillectomy after adjusting for the number of group A beta-hemolytic streptococcal pharyngitis infections per patient within the previous year and the presence of preexisting conditions. Among the children who developed a subsequent group A beta-hemolytic streptococcal pharyngitis infection, the children without a tonsillectomy developed a group A beta-hemolytic streptococcal pharyngeal infection sooner (median, 0.6 vs. 1.1 years). CONCLUSIONS: Tonsillectomy is associated with a decrease in the number of group A beta-hemolytic streptococcal pharyngitis infections in children with a history of recurrent groups A beta-hemolytic streptococcal pharyngitis infection. Tonsillectomy also increased the amount of time before development of further GABHS pharyngitis.

Adolescent↗

PubMed2006

Painless tonsillectomy.

PURPOSE OF REVIEW: Even though pediatric tonsillectomy is a well accepted treatment for upper airway obstruction or recurrent tonsillar infection, the painful recovery of this operation is unwelcome. As more studies are published on the beneficial effects of tonsillectomy, the number of tonsillectomies performed is likely to increase. It would behoove any surgeon performing this operation to be aware of the available options for post/perioperative pain control. RECENT FINDINGS: New techniques used to perform tonsillectomy, innovative adjuvant medical therapy and other tools are reviewed. SUMMARY: The search for 'the painless tonsillectomy' continues. Finding a technique that works best for each surgeon is paramount to successful tonsillectomy. Patient comfort, surgical time, complications such as bleeding and regrowth of tonsillar tissue, or recurrence of symptoms that lead to the initial operation should all be considered in the surgeon's choice of a particular tonsillectomy technique. Medical therapies such as corticosteroids in the perioperative period are well accepted as a pain adjuvant. Newer adjuvants include the use of pretonsillectomy injection of mixtures that include local anesthetics with opioids and clonidine. The use of nonsteroidal antiinflammatory drugs appears to be helpful for pain, but controversial regarding bleeding. Another successful strategy used to decrease pain perception is distraction.

Analgesics↗

PubMed1977

Evaluation of tonsillectomy as a treatment for pustulosis palmaris et plantaris.

Two hundred and eighty five cases of pustulosis palmaris et plantaris (PPP), of which 73 cases (25.6%) underwent tonsillectomy, were studied to evaluate the effectiveness of tonsillectomy as a treatment for PPP. The group of tonsillectomized patients showed significantly better results than a group which received other methods of treatment. A tendency to leukocytosis was observed in PPP which normalized, in many cases, after tonsillectomy. The shorter the period between the onset of PPP and tonsillectomy the better the results, and the quicker the response. A transient worsening of PPP after tonsillectomy did not after the prognosis. In order to determine if tonsillectomy was indicated, an ultrashort wave direct provocation test was conducted in which ultrashort wave was applied to the tonsil. Leukocytosis and worsening of PPP after the test was considered as an indication for tonsillectomy. In some cases, there were considerable changes in plasma cortisol levels and NBT test values after the provocation test. Improvement of PPP after the Impretol test (one of the annulation tests) in which Impretol was injected into the tonsil, appears to support the focal infection origin of PPP in these cases. There is a possibility that the Impretol test could be used as a treatment for PPP.

Adult↗

PubMed2003

Bacteraemia during tonsillectomy.

The aim of this study was to determine the incidence of bacteraemia during tonsillectomy and investigate the effect of the timing of culture sampling on the incidence of bacteraemia associated with it. Sixty-four consecutive patients who had been admitted for elective tonsillectomy were included in the study. Patients were randomly classified into two groups. Blood cultures as well as tonsillar surface and deep tissue cultures were obtained from all patients before tonsillectomy and 60 minutes after tonsillectomy. In addition, blood cultures were taken within two minutes following tonsillectomy for group 1 and 15 minutes after tonsillectomy for group 2. In group 1, the cultures obtained within two minutes were positive in nine patients, while only two of the blood cultures taken post-operatively were positive in group 2. The difference between the two groups was statistically significant (p < 0.05). The results of this study suggest that a transient bacteraemia occurs frequently in association with tonsillectomy, but the timing of culture sampling for its detection is important.

Adolescent↗

PubMed2004

Secondary post-tonsillectomy haemorrhage and informed consent.

This is a prospective incidence study of 250 secondary post-tonsillectomy haemorrhages from a population of 2706 tonsillectomies performed over a seven-year period, which aims to ascertain the incidence and character of post-tonsillectomy secondary haemorrhage. Out of 250 post-tonsillectomy secondary bleeds (9.2 per cent of total; 95 per cent CI = 8.2 per cent - 10.4 per cent), 39 patients had a severe bleed (1.4 per cent; 95 per cent CI = 1.2 per cent - 2.1 per cent). The incidence of secondary tonsillectomy haemorrhage increased with age, peaking at 30-34 years in both men and women (p < 0.001), with no statistically significant difference between the two sexes (p = 0.23). The incidence of serious haemorrhage increases in the older age categories (p = 0.005) but is not influenced by gender (p = 0.50). The majority of secondary tonsillectomy haemorrhages presented between the fourth and seventh day post-operation (69.8 per cent). These results now provide the basis for informed consent for a tonsillectomy in our department.

Adolescent↗

PubMed1993

Chronic tonsillitis and IgA nephropathy. Clinical study of patients with and without tonsillectomy.

To determine whether tonsillectomy is a significantly effective treatment in the clinical course of IgA nephropathy, we did a comparative study on 50 patients with IgA nephropathy and chronic tonsillitis. We divided the patients into two groups: 35 patients with and 15 without tonsillectomy (control group). With or without tonsillectomy, renal function became progressively worse during the follow-up period in most patients with a serum creatinine level of > 1.4 mg/dl at the time of renal biopsy. In patients with a serum creatinine level of < or = 1.4 mg/dl, renal function remained normal in all subjects with tonsillectomy, but worsened in 3 patients out of 13 without tonsillectomy. Improvement in proteinuria/hematuria was found more frequently in the tonsillectomized group than in the controls. Furthermore, the serum IgA level was significantly reduced after tonsillectomy, especially in patients showing improvement. From these results we conclude that tonsillectomy was effective for patients with IgA nephropathy complicated by tonsillitis when the operation was performed before deterioration of renal function.

Adult↗

PubMed1998

[Therapeutic effects and prognostic factors of tonsillectomy for IgA nephropathy in long-term follow-up].

I investigated several factors that can predict the effect of tonsillectomy for the prevention of renal failure in IgA nephropathy patients. Samples were obtained from 71 patients (35 male and 36 female) who were diagnosed as having IgA nephropathy by renal biopsy and the patients were followed-up for more than 5 years. Mean age at the time of renal biopsy was 28.3 years (8-58 years), and the mean follow-up period was 9 years 9 months (5-19 years). The overall remission rate of IgA nephropathy after tonsillectomy was 28.2%, and the retention rate of renal function was 90.1%, showing a considerably better prognosis than alternative therapies previously reported. Statistical analysis of multiple prognostic factors were examined including the following: sex, age-at-biopsy, renal pathological findings, renal function, serum IgA level, hypertension, past history of tonsillitis, preoperative results of tonsillar provocation test, and the period from diagnosis to tonsillectomy. A statistically significant poorer prognosis after tonsillectomy was observed in the following conditions: < or = 20-years-old when diagnosed, serum creatinine level > or = 1.3 mg/dl, urinary protein > or = 1.0 g/day, serum IgA level > or = 350 mg/dl. No other factors affected the prognosis of renal function statistically, including past history of tonsillitis or positive result of tonsillar provocation test. The present study indicates that there is a beneficial effect of tonsillectomy for mild to moderate IgA nephropathy and that this operation may be indicated for IgA nephropathy as long as the pathological grading is not advanced. On the other hand, tonsillectomy was not effective in cases with poor renal function. Although a past history of tonsillitis and positive results in tonsillar provocation tests have been widely considered as good indicators of tonsillectomy for IgA nephropathy, the present study showed no benefit to consideration of these factors preoperatively.

Adolescent↗

PubMed1994

[Taste disturbance after tonsillectomy].

There are some patients, though few in number, who complain of taste disturbance after tonsillectomy. Actual measurement of the distance between the lingual branch of the glossopharyngeal nerve, which controls taste in the posterior portion of the tongue, and the lower pole of the palatine tonsil, using a cadaver, showed the distance to be only 2-4 mm, thereby suggesting the danger of direct or indirect disturbance of this nerve by tonsillectomy. Among the 3,583 outpatients complaining of taste disturbance whom we have treated at our taste disorder clinic in the last 15 years, 11 (0.31%) were found to be suffering from taste disorder triggered by tonsillectomy. Among these 11 causes, the causes of taste disturbance have been identified in 8 cases. In three cases, the taste disturbance was caused by direct or indirect damage to the lingual branch of the glossopharyngeal nerve, whereas in another two cases, the disturbance was attributable to medication following tonsillectomy. In the remaining three cases, the diagnosis was a taste disturbance initiated by tonsillectomy but actually caused by a lack of dietary zinc. It is therefore important that patients be informed of the risk of post-operative taste disorder following tonsillectomy, at the time informed consent for tonsillectomy is obtained. It is equally important to measure the taste threshold values for each taste nerve and the serum zinc value as part of the pre-operational examination, and to ask the patients what drugs, if any, they take habitually.

Adult↗

PubMed1999

Tonsillectomy does not prevent a progressive course in IgA nephropathy.

BACKGROUND: IgA nephropathy, or Berger's disease, is a primary mesangioproliferative glomerulonephritis, usually with a favourable prognosis. PATIENTS AND METHODS: To investigate the effect of tonsillectomy we conducted a retrospective investigation on renal outcome in 55 patients with IgA nephropathy in an outpatient university clinic between 1968 and 1994. Established risk factors for progressive IgA nephropathy were equally distributed in 16 patients subjected to tonsillectomy and in 39 patients without tonsillectomy. Renal survival and impact of risk factors were estimated by Kaplan-Meier analysis and Cox regression model. RESULTS: Seen in terms of the bivariate Kaplan-Meier analysis the probability of renal survival 10 years after biopsy was 0.37 for the 16 patients with tonsillectomy and 0.63 for the 39 patients without tonsillectomy (log-rank test p = 0.49, not significant). In the multivariate Cox regression model with 6 independent clinical covariates, initially high serum creatinine concentration had the strongest impact on renal outcome (p = 0.002), with a hazard ratio of 8.9 (95% CI: 2.3-35.0). Tonsillectomy had no significant influence in the Cox model (p = 0.37), displaying a hazard ratio of 1.7 (95% CI: 0.5-5.7). CONCLUSION: In conclusion, tonsillectomy does not reduce the risk of developing renal failure or prevent a progressive course of IgA nephropathy.

Adult↗

PubMed2001

Association of MALTectomy (appendectomy and tonsillectomy) and inflammatory bowel disease: a familial case-control study.

UNLABELLED: There is some controversy regarding the prevalence of tonsillectomy and appendectomy among patients with Crohn's disease (CD) and a lower rate of appendectomy among patients with ulcerative colitis (UC). However, some environmental and familial factors that could alter those figures have not been studied. OBJECTIVE: To explore the prevalence of MALTectomy (appendectomy and tonsillectomy) among patients with IBD, stressing those factors that may be significantly associated to it. METHOD: Age-and-sex matched case-control study in patients with IBD, their relatives and the general population. Two hundred and eighty seven cases were IBD patients (153 UC, and 134 CD), the "family control" group included 203 siblings and the population-based control group included 570 individuals. Potential confounding factors, such as smoking, educational level, oral contraceptive use, place of birth and residence up to the age of 15 years, were ruled out. RESULTS: Appendectomy and UC: 7% of UC patients had undergone appendectomy versus 20% (OR: 0.23; 95% CI: 0.11-0.5; p < 0.0001) of controls. Appendectomy rates in families with at least one case of UC were 17/153 (6.3%) and 61/306 (20%) in the control group (p < 0.001). Appendectomy and CD: Twelve per cent of CD patients had undergone appendectomy six months before the onset of the disease versus 17% among the control population (OR: 0.43; 95% CI: 0.29-0.95; p < 0.01). The frequency of appendectomy in families with at least one case of CD was 22/221 (10%), which was significantly lower (p < 0.05) than among the control group 45/264 (17%). No differences were found between IBD patients and familial controls. Tonsillectomy and CD: Forty six per cent of CD patients had undergone tonsillectomy versus 39% of control patients (OR: 1.77; 95% CI: 0.92-2.05; p = ns). Tonsillectomy and UC: Twenty eight per cent of UC patients had undergone tonsillectomy versus 39% of the population control group (OR: 1.07; 95 CI: 0.57-1.25: p = ns). In fact, no differences were found regarding the prevalence of tonsillectomies within families with IBD cases as compared to population controls. CONCLUSIONS: Appendectomy is not only less frequent among CD and UC patients, but also among their relatives, thus suggesting the existence of environmental and genetic factors with opposed etiological roles in IBD and appendicitis.

Adolescent↗