14: Coincidental appendectomy in the surgical management of women with endometriosis and pelvic pain

Abstract

The purpose of this study is to describe the rate of appendiceal endometriosis (AppE) in women having coincidental appendectomy at time of gynecologic surgery for pelvic pain, stage I-II endometriosis, or stage III-IV endometriosis. Coincidental appendectomy as standard of care in surgery for endometriosis and chronic pelvic pain has not been widely adopted largely due to uncertainty as to the prevalence of appendiceal pathology and procedure safety. This is a retrospective case series in which data were obtained by review of an internal database, with validation of data through chart review, tracking women having coincidental appendectomy during surgery for endometriosis or pelvic pain. All patients were from an academic tertiary referral hospital in the Northeastern United States between March 2013 and June 2019. Our primary outcome is the association between surgically documented endometriosis and AppE. Secondary outcomes include AppE association with other pathology and complications associated with coincidental appendectomy. Six hundred nine consecutive women were included in the analysis. Intraoperative findings were evaluated categorically in the following groups: no endometriosis (n = 56, 9%), stage I-II endometriosis (n = 409, 67%), or stage III-IV endometriosis (n = 144, 24%). AppE was present in 14.6% of women and was significantly associated with the indication for appendectomy. AppE was present in 3.6% of women with no endometriosis, 8.3% with stage I-II endometriosis, and 37.5% with stage III-IV endometriosis. When compared to negative appendiceal pathology, AppE was significantly associated with endometriosis (OR 4.7, CI 2.4, 9.1, p < 0.001), and was not associated with the presence of adenomyosis or fibroids alone. There was no association between AppE and age or BMI. There were no intraoperative or postoperative complications related to coincidental appendectomy up to 12 weeks postoperative. Women with endometriosis have an increased risk of AppE, greatest with stage III-IV endometriosis. Given the high prevalence of AppE in this population and the minimal complication risk with coincidental appendectomy, it should form part of complete endometriosis excision for these patients.