Appendectomy Performed Routinely in the Laparoscopic Treatment of Endometriosis

Abstract

INTRODUCTION: Our aim was to evaluate the relevance of performing concomitant appendectomy for patients undergoing laparoscopic surgical treatment of endometriosis by assessment of appendiceal pathology. METHODS: Laparoscopic appendectomy was performed on 79 sequential women undergoing laparoscopic treatment of endometriosis between January 2011 and December 2013. The same surgeon performed all appendectomies. Patients undergoing excision and treatment of endometriosis received simultaneous appendectomy at the time of laparoscopic surgery as part of a comprehensive management of endometriosis. All appendectomies were performed using the Altrus thermal device (ConMed). RESULTS: Abnormal pathology of the appendix included fibrosis, fecalith, follicular lymphoid hyperplasia and fecal impaction in addition to the diagnoses designated as significant pathology. Significant pathology was defined as endometriosis, acute focal inflammation, early acute appendicitis or carcinoid tumor. 38/79 (48.1%) of patients had abnormal pathology and 11/79 (13.9%) demonstrated significant pathology. Average age for patients with normal pathology was 34.8 years and for patients with abnormal pathology the average age was 35.02 years. In this cohort, there were no surgical complications related to appendectomy. 3/79 (3.8%) of patients had a complication of surgery related to the extent of endometriosis. CONCLUSION: Pathology of the appendix is seen in a surprisingly high proportion of patients with surgically diagnosed endometriosis. Patients should be counseled that appendectomy performed at the time of laparoscopic surgical treatment of endometriosis may concomitantly treat benign or significant pathology of the appendix and should be considered as an important component of management.