The appendix (like tonsils and adenoids) is removed far too readily from early childhood onward.
Original statement
وانت لسه يا بيبي بتاخد لوز بتشيل لحميه بتشيل زايده بعديها تكبر شويه تعمل تكميم بعديها بحبه تستاصل مراره
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
The appendix (like tonsils and adenoids) is removed far too readily from early childhood onward.
Origin
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live!جوع الخلايا للسكر -٢-الأحماض الامينية (Open source)
- Published
- 21 October 2025
- Timestamp
- 0:46:00 (location in the original video’s automatic YouTube caption track; confirms where the words occur, not who speaks)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
- Claimed mechanism
Medicine's readiness to cut.
- Claimed health effect
Unnecessary operations.
- Population concerned
Children and adults
- Geographic restriction by Elawady
none found
Scientific assessment
Potentially true – Some evidence points in favour of the statement, but it is not sufficient for a clear judgement.
Certainty of evidence: low – Further research is likely to change the assessment considerably.
1. What was claimed?
Appendectomy is done too readily.
2. What is demonstrably correct?
Antibiotic treatment was noninferior for overall health at 30 days (CODA, I-ORG-07); 61% of antibiotic-treated patients avoided appendectomy for 5 years (APPAC, I-ORG-08); Swedish data document historical over-use (incidental and negative appendectomies) that declined strongly with better diagnostics: appendectomy incidence fell from 189.3 to 105.6 per 100,000 (ages 0-19: 236.2 to 96.4) between 1987 and 2009 (A-ORG-05).
3. What is wrong or exaggerated?
Appendicitis still requires treatment: 29% of the antibiotic group needed surgery within 90 days, and complications were higher with appendicolith (CODA). The Swedish decline shows past over-use, not current routine over-use (A-ORG-05). This does not support avoiding treatment or replacing it with diet.
4. What remains unclear?
Rates of unnecessary appendectomy in Egypt.
5. Which studies support it?
I-ORG-07, I-ORG-08; A-ORG-05 (historical over-use only).
6. Which studies contradict it?
I-ORG-07 (limits).
7. What applies to Germany and Europe?
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
8. What is known about Egypt?
No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.
9. What practical conclusion is appropriate?
In uncomplicated appendicitis, antibiotics are an evidence-based alternative to discuss with a surgeon; appendicitis is an emergency either way.
Assessment details
- Rationale for certainty of evidence
RCTs show that antibiotics can avoid appendectomy in many uncomplicated cases, and appendectomy rates fell in Sweden; but no data on 'unnecessary' appendectomy rates in Egypt were found.
- Source quality
Transcript statement; general.
- Regional transferability
European RCTs; Egyptian practice not assessed.
- Individual exceptions
Appendicitis with appendicolith or complications usually needs surgery.
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
Overinterpreted – A real finding exists, but the claim draws more from it than the data allow (e.g. association taken as cause, animal data applied to humans, small effect presented as large).
Research question: Is the appendix removed more often than necessary in children and adults, i.e. could many patients with appendicitis safely avoid appendectomy?
Research question in detail (PICO)
- Population
- Children and adults with suspected or uncomplicated appendicitis
- Intervention or exposure
- Appendectomy
- Comparison
- Antibiotic (non-operative) treatment; better diagnosis
- Geographic scope
- universal; practice varies by country
- Outcomes
- Treatment failure
- Avoided appendectomy
- Complications
- Negative appendectomy
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
Antibiotics instead of surgery for simple appendicitis
Doleman B et al.. Cochrane Database Syst Rev 2024 · PMID 38682788 · DOI 10.1002/14651858.CD015038.pub2 Meta-analysisabstract checkednewly addedCochrane 2024: about two thirds of antibiotic-treated (mostly adult) patients avoided appendectomy in year 1.
- Actual result
- 30.7% (24.0-37.8) needed appendectomy at 1 year.
- Methodological quality
- high (Cochrane; very low certainty for this outcome)
- Relevance
- direct
- Limitations
- Higher treatment failure (76/1000).
Finland: antibiotics for appendicitis after 5 years
Salminen P et al.. JAMA 2018 · PMID 30264120 · DOI 10.1001/jama.2018.13201 Randomised controlled trialabstract checkedAPPAC 5-year: 61% of adults with CT-confirmed uncomplicated appendicitis avoided surgery for 5 years.
- Actual result
- Recurrence 39.1%.
- Methodological quality
- high (RCT)
- Relevance
- direct
- Limitations
- Adults; CT-confirmed.
International guideline on appendicitis (2025)
Podda M et al.. JAMA Surg 2026 · PMID 41604201 · DOI 10.1001/jamasurg.2025.6218 Guideline / position statementabstract checkednewly addedWSES 2025: non-operative management safe in selected uncomplicated cases; scores and imaging reduce negative appendectomies.
- Actual result
- Guideline findings.
- Methodological quality
- high (GRADE guideline)
- Relevance
- direct
- Limitations
- Surgery remains standard.
What speaks against the claim?
Antibiotics versus surgery for appendicitis in children
St Peter SD et al.. Lancet 2025 · PMID 39826968 · DOI 10.1016/S0140-6736(24)02420-6 Randomised controlled trialabstract checkednewly addedLancet 2025 RCT in children: antibiotics failed in 34% vs 7% with surgery and were formally inferior.
- Actual result
- Difference 26.7% (90% CI 22.4-30.9).
- Methodological quality
- high (RCT)
- Relevance
- direct
- Limitations
- Asymmetric failure definitions.
Antibiotics instead of surgery for appendicitis
CODA Collaborative; Flum DR et al.. N Engl J Med 2020 · PMID 33017106 · DOI 10.1056/NEJMoa2014320 Randomised controlled trialabstract checkedCODA: complications higher with antibiotics, driven by appendicolith.
- Actual result
- 8.1 vs 3.5 per 100 (RR 2.28).
- Methodological quality
- high (RCT)
- Relevance
- direct
- Limitations
- Adults.
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
Some appendectomies could be avoided (selected uncomplicated cases can be treated with antibiotics; negative appendectomies still occur), but appendicitis always needs treatment and surgery remains the more reliable option, especially with appendicolith and in children.
Why some studies weigh more
Multiple RCTs and a Cochrane review; children-specific trials weigh most for 'from early childhood'.
Is a causal relationship established? Not applicable Question concerns appropriateness of practice, not causation.
Remaining uncertainty
Size of unnecessary removal in Egypt; long-term outcomes of antibiotics in children.
Justified conclusion
Partly supported: surgery is not always necessary, but 'far too readily' is not quantified and appendicitis must always be treated.
Why do studies seem to disagree?
St Peter 2025 (inferior) and van Amstel 2026 (similar complications) differ in outcome definitions (failure including negative appendicectomy vs complications) and inclusion (clinical vs imaging-confirmed diagnosis, faecolith excluded).
Does this depend on the country?
- General biological effects
- Universal.
- Eating habits
- Not relevant to this claim.
- Origin of the food
- Not applicable.
- Contaminants
- Not applicable.
- National production conditions
- Swedish appendectomy incidence in young people fell substantially over decades (A-ORG-05), showing practice changes over time.
- Legal rules
- Not applicable.
- Actual monitoring data
- No Egyptian data on appendectomy rates or non-operative management were found (PubMed search: 0 hits).
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- Recalculate risk difference with 90% CI; negative appendicectomy rate – RD 26.7% (22.5-31.0) reproduced; negative appendicectomy about 6.9% recalculated
- Complication risk difference – 0.7% (-5.8 to 7.1) reproduced recalculated
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- Avoidance of appendectomy with antibiotics in uncomplicated appendicitis
- Starting level
- high (randomised trials)
- Reasons for downgrading
- risk of bias (open-label)
- inconsistency (children vs adults)
- Result
- low
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Clinical guidelines and official statements checked
- World Society of Emergency Surgery: Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the WSES Jerusalem Guidelines (2025) · Original publication
Non-operative management with antibiotics is safe and effective in selected patients with uncomplicated appendicitis; clinical scores and imaging reduce negative appendectomies; laparoscopic appendectomy remains the standard surgical approach (abstract; I-ORG-109). 2020 edition (full text, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386163/): NOM recommended as a safe alternative in selected adults without appendicolith (strong, high quality) and suggested for children without appendicolith (weak, moderate), recurrence up to 39% at 5 years; NOM not suggested in pregnancy.
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| PubMed | 26 October 2026 | (appendicitis[ti]) AND (guideline[ti] OR guidelines[ti]) AND 2022:2026[dp] | guidelines | 16 | |
| Europe PMC | 26 October 2026 | appendicitis AND children AND (TITLE:nonoperative OR TITLE:"non-operative" OR TITLE:antibiotic OR TITLE:antibiotics) AND (TITLE:randomized OR TITLE:randomised OR TITLE:trial) | both directions | 50 | |
| Europe PMC | 26 October 2026 | JOURNAL:"Cochrane Database Syst Rev" AND TITLE:appendicitis | both directions | 18 | |
| Europe PMC | 26 October 2026 | (TITLE:"negative appendectomy" OR TITLE:"negative appendicectomy") AND (rate OR trends) AND (children OR paediatric OR pediatric) | supporting evidence | 44 | |
| PubMed | 26 October 2026 | (appendicitis[ti]) AND (Egypt[tiab] OR Egyptian[tiab]) AND (antibiotic* OR non-operative OR nonoperative) | both directions | 0 | |
| PubMed | 26 October 2026 | Jerusalem guidelines diagnosis treatment acute appendicitis 2020 update | guidelines | 2 |
Open questions
Negative appendectomy and appendectomy rates in Egypt.
How deeply was this checked?
7 linked studies: 1 checked in full text (1 of them with a structured risk-of-bias assessment), 6 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: Potentially true (low)
- 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: Potentially true (low)
Unchanged (“Potentially true”, low). New paediatric RCTs cut both ways: two thirds avoid surgery, but antibiotics fail more often in children.
New sources: I-ORG-106 I-ORG-109 I-ORG-107 I-ORG-108
In plain language
Elawady said appendix removal is done too easily. Trials show that many people with uncomplicated appendicitis can be treated with antibiotics instead of surgery, so surgery is not always necessary. But appendicitis must always be treated: about 3 in 10 people treated with antibiotics still needed an operation within three months.
Studies on this claim
Studies supporting the claim (4)
-
Antibiotics instead of surgery for appendicitis
CODA Collaborative; Flum DR et al.. N Engl J Med 2020 · PMID 33017106 · DOI 10.1056/NEJMoa2014320Randomised controlled trialindependent cross-checkabstract checked★ key studyAntibiotics worked about as well for overall health at 30 days, but 29% still needed surgery within 90 days.
The appendix (like tonsils and adenoids) is removed far too readily from early childhood onward.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Appendicitis treatment
- How was the study done?
RCT
- How many people, animals or samples were studied?
1552
- What was actually found?
Antibiotics noninferior; many later surgeries
- How large was the observed effect?
29% appendectomy by 90 d
- What do the results mean in everyday life?
Surgery is not the only option, but appendicitis must be treated
- What are the study's limitations?
Unblinded
- What does it say about Elawady's specific claim?
Partly supports 'not always remove'
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Diet-based treatment
-
Finland: antibiotics for appendicitis after 5 years
Salminen P et al.. JAMA 2018 · PMID 30264120 · DOI 10.1001/jama.2018.13201Randomised controlled trialindependent cross-checkabstract checkedAbout 61% treated with antibiotics never needed their appendix removed in 5 years.
The appendix (like tonsils and adenoids) is removed far too readily from early childhood onward.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Long-term
- How was the study done?
RCT follow-up
- How many people, animals or samples were studied?
530
- What was actually found?
39.1% recurrence
- How large was the observed effect?
39.1%
- What do the results mean in everyday life?
Many can avoid surgery
- What are the study's limitations?
Open surgery comparator
- What does it say about Elawady's specific claim?
Partly supports
- Do the results apply to Germany and Europe?
European
- What can explicitly not be concluded from this study?
Complicated appendicitis
-
Antibiotics instead of surgery for simple appendicitis
Doleman B et al.. Cochrane Database Syst Rev 2024 · PMID 38682788 · DOI 10.1002/14651858.CD015038.pub2Meta-analysisindependent cross-checkabstract checked★ key studyAbout two thirds of adults treated with antibiotics avoided an operation in the first year, but treatment failed more often than with surgery.
About two thirds of selected patients avoided surgery in year 1 with antibiotics, so routine removal is not always necessary.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Compare antibiotics with appendix removal
- How was the study done?
Cochrane review of 13 randomised trials
- How many people, animals or samples were studied?
About 3,360 mostly adult patients
- What was actually found?
More failures with antibiotics; fewer wound infections; 30.7% needed surgery within a year
- How large was the observed effect?
76 more failures per 1000
- What do the results mean in everyday life?
Antibiotics are an option for selected simple appendicitis
- What are the study's limitations?
Mostly low-certainty evidence
- What does it say about Elawady's specific claim?
Supports that surgery is not always needed; not that appendicitis can be left untreated
- Do the results apply to Germany and Europe?
Directly applicable
- What can explicitly not be concluded from this study?
Not about diet; not about complicated appendicitis
-
International guideline on appendicitis (2025)
Podda M et al.. JAMA Surg 2026 · PMID 41604201 · DOI 10.1001/jamasurg.2025.6218Guideline / position statementindependent cross-checkabstract checked★ key studyAntibiotics can be used in selected simple cases and better diagnosis reduces unnecessary operations, but surgery remains the standard treatment.
Guideline aims to reduce negative appendectomies and endorses non-operative management in selected cases.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Give evidence-based advice for appendicitis care
- How was the study done?
GRADE-based international guideline
- How many people, animals or samples were studied?
19 questions, 35 recommendations
- What was actually found?
Antibiotics an option in selected cases; laparoscopic surgery standard
- How large was the observed effect?
n/a
- What do the results mean in everyday life?
Both treatments are accepted; appendicitis must be treated
- What are the study's limitations?
Full text not read
- What does it say about Elawady's specific claim?
Partly supports avoiding unnecessary removal
- Do the results apply to Germany and Europe?
Applies in Europe and elsewhere
- What can explicitly not be concluded from this study?
Not about diet
No study in this group is marked as key.
Studies contradicting or limiting the claim (1)
-
Antibiotics versus surgery for appendicitis in children
St Peter SD et al.. Lancet 2025 · PMID 39826968 · DOI 10.1016/S0140-6736(24)02420-6Randomised controlled trialindependent cross-checkabstract checked★ key studyAntibiotics failed in 34% of children versus 7% with surgery, but about two thirds of antibiotic-treated children kept their appendix for a year.
Antibiotics were inferior to surgery in children by the trial definition; about 7% negative appendicectomies show some unnecessary removals.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Test antibiotics against surgery for uncomplicated appendicitis in children
- How was the study done?
International randomised trial
- How many people, animals or samples were studied?
936 children aged 5-16
- What was actually found?
Antibiotics inferior by the trial margin; no deaths or serious harms
- How large was the observed effect?
Failure 34% vs 7%
- What do the results mean in everyday life?
Surgery remains the more reliable treatment in children; antibiotics are an option with a high failure rate
- What are the study's limitations?
Unblinded; different failure definitions
- What does it say about Elawady's specific claim?
Limits the claim that appendices are removed far too readily
- Do the results apply to Germany and Europe?
Directly applicable
- What can explicitly not be concluded from this study?
Not about diet or untreated appendicitis
No study in this group is marked as key.
Studies with mixed or unclear results (2)
-
Appendix removal and bowel cancer
Song H et al.. PLoS One 2016 · PMID 26959234 · DOI 10.1371/journal.pone.0151262Cohort studycited by the Tayebat archivefull text, structured risk-of-bias assessmentNo increased risk of stomach, colon or rectal cancer after appendix removal.
The appendix (like tonsils and adenoids) is removed far too readily from early childhood onward.
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Cancer risk
- How was the study done?
Register
- How many people, animals or samples were studied?
480,382
- What was actually found?
No excess
- How large was the observed effect?
SIR EAC 1.32
- What do the results mean in everyday life?
Appendectomy did not raise most GI cancers
- What are the study's limitations?
SIR design
- What does it say about Elawady's specific claim?
Contradicts archive summary
- Do the results apply to Germany and Europe?
European
- What can explicitly not be concluded from this study?
Small risks
-
Antibiotic strategy for simple appendicitis in Dutch children
van Amstel P et al.. BMJ Med 2026 · PMID 42157906 · DOI 10.1136/bmjmed-2025-002466Randomised controlled trialindependent cross-checkabstract checkedAbout 70% of children treated with antibiotics avoided an operation, with similar complication rates, but non-inferiority was not proven.
70% avoided surgery with antibiotics; non-inferiority for complications not proven.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Compare a non-operative strategy with surgery
- How was the study done?
Randomised trial
- How many people, animals or samples were studied?
302 children aged 7-17
- What was actually found?
Complications 9.3% vs 8.6%; 69.5% avoided surgery
- How large was the observed effect?
Risk difference 0.7%
- What do the results mean in everyday life?
Antibiotics are a possible option for selected children
- What are the study's limitations?
Unblinded, moderate size
- What does it say about Elawady's specific claim?
Partly supports avoiding some operations; appendicitis still needs treatment
- Do the results apply to Germany and Europe?
Directly applicable
- What can explicitly not be concluded from this study?
Cannot show equivalence
No study in this group is marked as key.
Regional context
Germany / EU
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
Egypt
No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.
What applies in my country?
General scientific assessment
Potentially true Partly supported: surgery is not always necessary, but appendicitis always needs treatment.
This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.
References
- A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis.. CODA Collaborative; Flum DR et al.. N Engl J Med 2020 · PMID 33017106 · DOI 10.1056/NEJMoa2014320
- Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial.. Salminen P et al.. JAMA 2018 · PMID 30264120 · DOI 10.1001/jama.2018.13201
- Appendectomy versus antibiotic treatment for acute appendicitis.. Doleman B et al.. Cochrane Database Syst Rev 2024 · PMID 38682788 · DOI 10.1002/14651858.CD015038.pub2
- Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines.. Podda M et al.. JAMA Surg 2026 · PMID 41604201 · DOI 10.1001/jamasurg.2025.6218
- Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children: an open-label, international, multicentre, randomised, non-inferiority trial.. St Peter SD et al.. Lancet 2025 · PMID 39826968 · DOI 10.1016/S0140-6736(24)02420-6
- Risk of Gastrointestinal Cancers among Patients with Appendectomy: A Large-Scale Swedish Register-Based Cohort Study during 1970-2009.. Song H et al.. PLoS One 2016 · PMID 26959234 · DOI 10.1371/journal.pone.0151262
- Non-operative treatment strategy versus surgery for children with simple appendicitis: non-inferiority randomised controlled trial.. van Amstel P et al.. BMJ Med 2026 · PMID 42157906 · DOI 10.1136/bmjmed-2025-002466