2462 Don't Forget the Appendix! Incidental Appendix Findings During Laparoscopic Pelvic Surgery

Abstract

Study Objective Evaluate the incidence of appendectomy for grossly abnormal appearance during laparoscopic gynecologic surgery for benign indications and pathologic concordance. Design Retrospective chart review of patients who underwent an appendectomy during laparoscopic gynecologic surgery for other indications. Setting Surgeries by Advanced Gynecologic Surgery Institute (AGSI), a group of three highly skilled minimally invasive gynecologic surgeons, at three community hospitals in the Chicago area. Patients or Participants A total of 3,478 patients underwent laparoscopic surgery by AGSI between January 1, 2013 through February 28, 2018. Seventy-three patients underwent appendectomy, and fifty-six were included in final analysis. All patients were 18 years of age or older with available operative and pathology reports. Interventions IRB approval was obtained and a retrospective chart review conducted using outpatient and inpatient electronic medical records. Measurements and Main Results Patients were assessed for age, body mass index, surgical indication, procedure performed, intra-operative appendiceal findings, blood loss, pathology, intra-operative events, and postoperative complications. Intraoperatively, the most common indication for appendectomy was endometriosis or fibrosis (61.8%) of which 58.8% had confirmatory pathology and 23.5% had normal pathology. Overall, 75.0% of the specimens were positive for a pathologic process. Four (7.2%) appendiceal malignancies were found, three mucinous and one carcinoid tumor. All three patients with mucinous tumors were operated on by a general surgeon, at same time of gynecologic surgery (1) or at a later date (2). No significant sequelae occurred. Conclusion The appendix should be evaluated during gynecologic laparoscopy, as incidental findings may be identified including malignancies. It is safe for trained gynecologists to perform a laparoscopic appendectomy, but a general surgeon should be consulted intra-operatively when a suspicious mass or malignancy is noted. Future research could evaluate postoperative pain profiles, increased costs and surgical time, and incidence of appendiceal pathology in the endometriosis population.