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A recenct article on the BBC news got me wondering about Astronauts in the ISS. technically they are fewer miles from the closest hospital, but the transportation is bit more complex.

Imagine that you had to remove your appendix to live in your hometown – and your family had to do the same.

That’s the only option for long-term residents – even the children – of Villas Las Estrellas, one of the few settlements in Antarctica where some people live for years rather than weeks or months.

Appendix removal is a necessary precaution for the handful of people who stay longer-term because the nearest major hospital is more than 1,000km (625 miles) away, past the tip of King George Island and on the other side of the Southern Ocean’s icy swell. There are only a few doctors on base, and none are specialist surgeons.

Do Astronauts have their appendix removed, before going to space?

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James Jenkins
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    Heh, "only option" - as if people haven't lived for thousands of years before medical care was available. One can always take the risk also.. – jpa Sep 04 '18 at 14:20
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    @jpa maybe it is more appropriate to say people have been dying for thousands of years without medical care. A bit out of scope but I think the Antarctica practice is for the benefit of rescue workers. People die trying to get others to medical assistance. Appendicitis is 100% preventable. – James Jenkins Sep 04 '18 at 14:46
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    @jpa There are a lot of things that happened for "thousands of years" that I'm glad don't happen now. – Lightness Races in Orbit Sep 04 '18 at 17:31
  • Do you have a source for the statement that "Appendicitis is 100% preventable"? I've looked and many sources say there is no medically proven way to prevent it, just diets that seem to avoid it, but still not 100%. – computercarguy Sep 04 '18 at 19:54
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    @computercarguy You can't have an inflamed appendix if it has been removed. I don't know if that really needs a source. – Moyli Sep 04 '18 at 20:15
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    Just for the record: in 1961, a Russian doctor called Leonid Rogozov was at an Antarctic base when he developed appendicitis. No one was able to operate on him, and due to bad weather it was not possible to fly him to another place, so he had no choice but to operate on himself, with the others holding a mirror and handing him the tools. He succeeded and survived. Not really an option I'd rely on, but at least it makes for a nice story! – Fabio says Reinstate Monica Sep 04 '18 at 21:01
  • Maybe we should mention: in contrast to common belief, the appendix does actually fulfill a task (reservoir for gut bacteria) even if the task is less important for civilized humans, where cases of diarrhea are muss less common than for our earlier ancestors. – CallMeTom Aug 22 '22 at 05:47

2 Answers2

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No, but it is being considered, in particular for long duration deep space missions like going to the Moon. ISS astronauts could return to Earth in a short enough period of time that they could receive the medical care required if needed. Also being considered is removing one's gall bladder prior to this long duration mission.

PearsonArtPhoto
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    Might become a moot point with advances in telerobotic surgery, though, which is only a couple of years away. (Which, however, we have been told for a couple of couple of years now :-D ) – Jörg W Mittag Sep 04 '18 at 12:33
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    Most of the telerobotics I've seen involve doing a remote surgery, with a person in one location doing the work via a robot. I doubt that would work with a multiple minute light delay... – PearsonArtPhoto Sep 04 '18 at 12:36
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    Telerobotic surgery has been a couple of years away for a long time @JörgWMittag. Surgery in zero and low g is not something we fully understand, and would need to be avoided. – GdD Sep 04 '18 at 13:04
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    New related question Is telerobotic surgery logistically feasible in orbit? – James Jenkins Sep 04 '18 at 13:10
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    I’m disappointed the answer isn’t “emergency surgery is part of the astronauts’ training”. – Emil Jeřábek Sep 04 '18 at 13:53
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    @EmilJeřábek Unless it's an immediately life-threatening condition (which they are trained to deal with) it's safer to deorbit the patient. Long duration space missions, obviously, won't have this option. – Organic Marble Sep 04 '18 at 14:07
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    Related: https://space.stackexchange.com/questions/23391/how-can-astronauts-on-iss-deal-with-dental-emergency – Organic Marble Sep 04 '18 at 14:08
  • Hrm. So when will the first human with an appendix walk on Mars? – Martin Schröder Sep 04 '18 at 22:20
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    Just a continuation of what @GdD said about low/0 G surgery. If you look at how a liquid behaves in 0 g, you can potentially have droplets of blood floating around in your abdomen and congeal. Cleaning up of a spray of floating blood droplets is very different than cleaning up a pool of blood. After they congeal and harden, we don't know how that interacts with your organs when it floats and bounces around your internal cavities... far too many unknowns to make low/0 g surgeries safe at the moment. – Nelson Sep 05 '18 at 00:39
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    I can imagine a scab creating a sharp edge, and if it happens to go somewhere tight and pressure is applied, I can see it rupture an organ deep inside your body. You probably don't even need a sharp edge to cause lots of damage, especially on the trip back and gravity starts affecting you. – Nelson Sep 05 '18 at 00:41
  • Linked article actually mentions: ...nonoperative treatment of both disease processes is not uncommon. More specifically, nonoperative therapies (bowel rest, intravenous fluids, nasogastric decompression, antibiotics) have often been required in remote medical care situations with poor surgical capabilities. Whether limited by surgical equipment or human training, most reported nonoperative cases have had good results. These include a particularly long history aboard naval submarines with success rates approaching 90%. – Blake Walsh Sep 05 '18 at 08:54
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Answer: Routine preventative appendectomy is a bad idea.

Preventative appendectomy can only be advised if there is a net benefit. To determine this, the risks of preventative appedectomy need to be determined as well as effectiveness of non- surgical treatment.

It is easy (but not necessarily true) to assume that

  1. preventative appendectomy is harmless
  2. acute appendicitis is fatal without surgery.
  3. the appendix is useless and there is no downside to removing it even if healthy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502196 is a good review on conservative (non-operative) treatment of appendicitis. There have been numerous studies conducted on this by the military and fishing fleets. There have been several large series (200-500 patients) treated by antibiotics alone.

In this study, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502196, patients with acute appendicitis were treated with high dose antibiotics. Only one patient in 20 failed to respond to antibiotics alone and required surgery.

Complications of appendectomy include a lifetime increase risk of surgery for bowel obstruction (1.1% in the 5 years after surgery). https://www.hopkinsmedicine.org/health/conditions-and-diseases/appendicitis#:~:text=Appendicitis%20affects%201%20in%201%2C000,the%20risk%20of%20getting%20appendicitis .

The annual risk of appendicitis is 1:1000. So if you do 1000 preventative appendectomies, you would cause 11 surgical cases of potentially fatal bowel obstruction, just to prevent one case of appendicitis.

And what of that single case of appendicitis which could have been prevented by operating on a thousand healthy people? If that appendicitis case is treated promptly with high dose antibiotics, it has a 95% chance of a cure.

The argument for preventative appendectomy is not looking good. Suppose you are heading to Mars and are offered a farewell appendectomy. There is a 1% chance of developing a potentially fatal bowel obstruction following surgery. If you don’t have the appendectomy, you have a <0.01% chance of dying from appendicitis which failed to respond to antibiotics.

Woody
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    "The risk of appendicitis is 1:1000." should be the risk in the whole lifetime? Then the risk during a, say, 5 year mission to boldly go where no man has gone before, is only 1:16000. – asdfex Aug 21 '22 at 08:17
  • The question asks if it is done, not if you think it is a good idea. – Organic Marble Aug 21 '22 at 11:56
  • @asdfex ... good point. The risk of appendicitis varies widely by age, gender and geography but is roughly 1;1000 per year. – Woody Aug 21 '22 at 15:43