We had a discussion a ways back where incidental surgery was brought up. It's a topic that I find very interesting, since most of the data on incidental surgery is very old and outdated. I don't know about the rest of you, but in my program, we perform very little incidental surgery. We don't palpate the gallbladder and take it out if there's stones. We don't take the healthy appendix (if we're there for another reason), or remove an asymptomatic Meckel's. Are we doing the right thing for our patients? Would they benefit from these simultaneous procedures? One of the chiefs from my program did a Grand Rounds presentation on this topic, and he presented some very interesting information. He asked the three questions: 1. Is it safe? 2. Will it prevent future problems? 3. Is it cost-effective? His answers were surprising. I won't plagiarize him here, but a brief summary of his conclusions (these were his recommendations, not existing guidelines): Incidental Appy: You should remove the appendix in open procedures if the patient is less than 50 yo. (Laparoscopic removal with stapler removed cost-effectiveness, and older patients significantly increased the number needed to treat) Incidental Cholecystectomy: You should remove the gallbag if stones are discovered while doing an open colon resection, open AAA, and open or lap gastric bypass. Incidental Meckel's Diverticulectomy: You should remove if the patient has three of four of these are present: Male, diverticulum length >2cm, age <50yo, or presence of a fibrous band. Anyway, I found this topic interesting and wondered what some of you think. Should we be palpating the gallbladder during colon operations and removing it if there are stones? The literature would support such a decision. Should we be removing appendices while in there for another reason? I don't know the answer...... I have references and a very abridged version of the presentation that I can email people if they PM me.