Appendectomy Should Be Performed During Minimally Invasive Surgery for Endometriosis

Abstract

Objectives: To determine the prevalence of appendiceal histopathology in patients with confirmed endometriosis following minimally invasive surgery (MIS) for endometriosis. To determine whether pre-operative symptoms, age, intra-operative appendiceal appearance, or endometrioma laterality were associated with appendix histopathology in patients with suspected endometriosis.Methods: One hundred thirty-five patients ages 16-52 with suspected endometriosis undergoing MIS for endometriosis with concomitant appendectomy at two metropolitan academic hospitals from January 1, 2012 to June 30, 2017 were included in this retrospective chart-review study. Medical records were reviewed for pre-operative symptoms, age, intraoperative appendix appearance, appendix histopathology, histopathologically-confirmed endometriosis, and endometriomas.Results: In patients with confirmed endometriosis, the prevalence of all appendiceal histopathology was 25%, which included appendiceal endometriosis (18%), appendiceal tumors (2%), and inflammation (5%). Dyspareunia was the only pre-operative symptom significantly associated with appendiceal histopathology (p = 0.04). The presence of a right endometrioma was associated with appendiceal histopathology (p = 0.009). Additionally, appendiceal histopathology was not significantly associated with age nor intra-operative appendiceal characteristics. Conclusion:This manuscript adds to the limited pool of studies regarding appendiceal histopathology and appendiceal tumors in patients with suspected and confirmed endometriosis. On the basis of the high rate of histopathological appendices found in this population; the lack of association with possible diagnostic factors such as age, most pre-operative symptoms, and intra-operative appendiceal characteristics; and the relatively low risks of concomitant appendectomy, we suggest that surgeons consider concomitant appendectomies at the time of MIS for endometriosis.

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.…”

“…(Obstet Gynecol 2023;141:354-60) DOI: 10.1097/AOG.0000000000005033 C oncomitant appendectomy at the time of gynecologic surgery for benign indications can be performed in the surgical evaluation and treatment of endometriosis and chronic pelvic pain. 1,2 Studies have shown the incidence of appendiceal endometriosis is as high as 50% in patients with severe endometriosis. [3][4][5] Additionally, there are data to support that appendectomy can lead to significant improvement in patients with unexplained chronic pelvic pain.…”

“…1,6 Studies have demonstrated the benefit of appendectomy in the reduction of pelvic pain and endometriosis, and the benefits of appendectomy may outweigh the increased risk of sepsis and readmission when indicated. [1][2][3][4][5][6] These data should be used toward counseling patients about their postoperative risks.…”

Evolving best practices in the surgical management of endometriosis – examining the evidence and expert opinion

“…The majority of patients ultimately diagnosed with appendiceal endometriosis had a normal-appearing appendix intraoperatively [46 ▪ ]. Another 2021 retrospective study of 135 patients undergoing laparoscopy for suspected endometriosis found a prevalence of 18% of appendiceal endometriosis, again with no correlation between appendiceal pathology and intraoperative appearance [47].…”

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

“…However, complication rates have not been shown to increase in retrospective and prospective case series and randomized trials [4]. In most gynaecologic studies that include complication rates in their cohorts, gynaecologic surgeons are primarily performing the appendectomy [3,4,5 ▪▪ ,6,8,10]. No studies are available that compare appendectomy complication rates between gynaecologic and general surgeons.…”