Appendectomy in the surgical management of women with endometriosis and pelvic pain

Abstract

Objective To evaluate the role of appendectomy in surgical excision of endometriosis and to assess complications associated with appendectomy. Methods Retrospective study of women undergoing appendectomy for pelvic pain and/or endometriosis during a primary gynecologic procedure. Results Record review was performed for 609 women who underwent appendectomy between 2013 and 2019 for pelvic pain (6.9%, 42/609), stage I–II endometriosis (63.7%, 388/609), or stage III–IV endometriosis (29.4%, 179/609). Appendiceal endometriosis (AppE) was present in 14.9% (91/609); 2.4% without endometriosis (1/42, reference group), 7.0% with stage I–II endometriosis (27/388, odds ratio [OR] 3.06, 95% confidence interval [CI] 0.41–23.11, P = 0.278), and 35.2% with stage III–IV endometriosis (63/179, OR 22.24, 95% CI 2.99–165.40, P = 0.002). AppE was significantly associated with endometriosis present in other locations (OR 5.27, 95% CI 2.66–10.43, P < 0.001). The predicted probability of identifying AppE ranged from 6% with 0 positive endometriosis sites to 56% when 4 or more sites were identified. There were no complications related to the performance of an appendectomy. Conclusion Women with chronic pelvic pain and/or endometriosis have an increased risk of AppE. Modern appendectomy at the time of gynecologic surgery is safe, with no associated complications in this study. Our findings support the consideration of appendectomy as part of the comprehensive surgical management of endometriosis.

Appendectomy in endometriosis: an update on surgical indications and management of uncommon diseases

“…The likelihood of appendiceal disease with endometriosis was significantly higher in women with stage III-IV endometriosis compared with those with chronic pelvic pain or in women with an abnormal appearing appendix. No complications were found related to the performance of an appendectomy [5 ▪▪ ].…”

“…In a study by Ross et al . [5 ▪▪ ], the role of appendectomy in surgical excision of endometriosis or chronic pelvic pain was assessed in a retrospective study wherein patients undergoing a laparoscopic gynaecologic procedure were consented for a possible appendectomy. The decision to perform an appendectomy was at the surgeon's discretion.…”

“…The appendix may appear thickened, scarred, adhered to nearby structures, nodular, edematous, discoloured, misshapen or even completely normal. It is worth emphasizing that an appendix with a normal appearance does not rule out the possibility of identifying endometriosis on histopathology [3,4,5 ▪▪ ,6]. In addition to encountering AppE in patients undergoing surgery for endometriosis, up to 50% of cases have abnormal disease [4,7,8].…”

Postoperative Complications of Appendectomy in Gynecologic Laparoscopic Surgery for Benign Indications

“…1,6 However, the practice of concomitant appendectomy at the time of a gynecologic procedure remains controversial, and many gynecologic surgeons do not perform appendectomy due to the concern for increased risks of infection, ileus, blood loss, operating time, and morbidity. 1,2 Although single-institution studies support the safety and cost effectiveness of concomitant appendectomy in gynecologic surgery for benign indications, 1,7,8 other studies have shown increased risk of postoperative complications. 9,10 A large retrospective cohort study of patients with ovarian cancer who underwent noncytoreductive staging procedures demonstrated that patients who had concomitant appendectomy were two times more likely to have a postoperative surgical site infection.…”

The role of minimally invasive gynecologic surgeons in the era of subspecialties: when to refer and consult

“…Advanced procedures are necessary to remove the high burden of disease; in such cases of extrapelvic endometriosis involving the anterior abdominal wall, the appendix, the diaphragm and the thorax, it may be necessary to perform additional procedures that are not traditionally performed by all gynecologic surgeons [29][30][31]. Several authors describe surgical complexity for endometriosis, which also involves the bowel, bladder, and ureters [27,32].…”