Coincidental Appendectomy Research Articles

Appendiceal Endometriosis: A Comprehensive Review of the Literature.

Objective: the purpose of this review was to evaluate the prevalence of appendiceal endometriosis and the safety of concomitant appendectomy in women with endometriosis or pelvic pain. Materials and Methods: We searched the electronic databases Medline (PubMed), Scopus, Embase, and Web of Science (WOS). The search was not subject to any limitation in terms of time or method. The primary research question was: what is the prevalence of appendiceal endometriosis? The secondary research question was: is it safe to perform appendectomy during surgery for endometriosis? Publications that reported data about appendiceal endometriosis or appendectomy in women with endometriosis were reviewed regarding the inclusion criteria. Results: We found 1418 records. After review and screening, we included 75 studies published between 1975 and 2021. With regard to the first question of the review, we found 65 eligible studies and divided these into the following two categories: (a) endometriosis of the appendix presenting as acute appendicitis, and (b) endometriosis of the appendix as an incidental finding in gynecological surgery. Forty-four case reports described appendiceal endometriosis in women who were admitted for the treatment of pain in the right-sided lower abdomen. Endometriosis of the appendix was observed in 2.67% (range, 0.36-23%) of women who were admitted due to acute appendicitis. In addition, appendiceal endometriosis was an incidental finding during gynecological surgery in 7.23% of cases (range, 1-44.3%). With regard to the second question of the review, which was the safety of appendectomy in women with endometriosis or pelvic pain, we found 11 eligible studies. Reviewed cases had no significant intraoperative or follow-up complications during the 12 weeks. Conclusion: Based on the reviewed studies, coincidental appendectomy appears reasonably safe and was associated with no complications in the cases reviewed for the present report.

SP9.1.5 Occult appendix pathology in patients undergoing colorectal cancer resection suggests a role for appendectomy at left colon or rectal cancer resection

Abstract Aims There is epidemiological evidence suggesting that the incidence of appendicular neoplasms is increasing. The purpose of this study is to assess the incidence of appendix neoplasms in patients undergoing colorectal cancer resection in a unit where standard of care is appendectomy, with consent, when left colon or rectal cancer resection is performed. Methods This is a retrospective single-centre study on a prospectively collected data base of 718 consecutive patients undergoing colorectal cancer resection between January 2015 and June 2021. The primary outcome was the proportion of histologically abnormal appendix specimens at incidental appendectomy. Secondary outcome was complications from incidental appendectomy. Results Overall, 222/718(31%) patients had previous appendectomy. The remaining 496 comprised 169/496 (34%) who had a right-/extended-right hemicolectomy or sub-total colectomy which incorporates appendectomy, and 327/496(66%) who had left-sided resection (left-hemicolectomy, anterior resection or abdomino-perineal excision) with incidental appendectomy. At definitive histology, 454(92%) had a normal appendix, 13(2.6%) had inflammatory appendix pathology, 17(3.4%) had a hyperplastic/serrated polyp and 12(2.4%) had an appendix neoplasm, which included 5 carcinoids and 7 low-grade appendiceal mucinous neoplasms (LAMN). In the 327 patients who had incidental appendectomy, 7(2.1%) had a neoplasm (4 carcinoid and 3 LAMN). There were no complications attributable to appendectomy. Conclusion Patients undergoing left sided colorectal cancer surgery with an appendix in situ should be counselled on the benefits of co-incidental appendectomy to treat the small proportion with synchronous neoplasms and inflammation and eradicate the risk of metachronous appendicitis or a subsequent appendix tumour.

A New Approach to Coincidental Appendectomy: The Vaginal Appendectomy

Study Objective The objective of this video is to describe performance of a coincidental appendectomy at time of laparoscopic hysterectomy via vaginal access. This technique, the vaginal appendectomy (VagAppy), is beneficial as it allows performance of a coincidental appendectomy and specimen retrieval through the colpotomy. Design This is an observational case series of coincidental appendectomies performed via conventional “straight stick” and robotic-assisted laparoscopy. Stepwise demonstration of the vaginal appendectomy technique is provided with narrated video footage. Setting The surgeries in this video were performed in the operating room at an academic medical center. The patients were positioned in dorsal lithotomy position, and the hysterectomies were completed using 5mm ports (straight stick hysterectomy) and 8mm ports (robotic-assisted hysterectomy). Patients or Participants Women electing for total laparoscopic hysterectomy for the surgical management of endometriosis or chronic pelvic pain. Interventions Coincidental appendectomy at time of total laparoscopic hysterectomy. Measurements and Main Results No analyses were completed for this video. Conclusion Vaginal appendectomy is a feasible and efficient technique to perform coincidental appendectomy at time of laparoscopic hysterectomy using a transvaginal approach. It allows for the appendectomy to be completed with a laparoscopic stapler using small or reduced laparoscopic ports.

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

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.

57: Tips and tricks: A new approach to coincidental appendectomy: The vaginal appendectomy (VAGAPPY)

57: Tips and tricks: A new approach to coincidental appendectomy: The vaginal appendectomy (VAGAPPY)

Appendiceal Endometriosis: Is Diagnosis Dependent on Pathology Evaluation? A Prospective Cohort Study

To evaluate the diagnosis of appendiceal endometriosis (AppE) in coincidental appendectomy specimens using standard versus modified histopathologic analysis. Prospective analysis of 300 consecutive patients undergoing coincidental appendectomy at the time of a primary gynecologic procedure. Academic tertiary referral hospital in the northeastern United States. Women aged 22 to 52 years undergoing gynecologic surgery for the management of endometriosis or chronic pelvic pain between 2013 and 2015. Each appendix specimen underwent standard pathologic analysis with 4 sections performed. Modified pathologic analysis, consisting of standard analysis plus serial sectioning and complete evaluation of the appendix and mesoappendix, was then performed. The first pathologist reviewed all the slides to render a diagnosis. The slides of the subjects with abnormal pathology were rereviewed. On rereview, the diagnosis was confirmed, and the data on which protocol, standard or modified, achieved the diagnosis was rendered. The pathologist performing the second review was blinded to whether the slides from the standard or modified histopathology protocol achieved the original diagnosis. This allowed each specimen to serve as its own control. The primary outcome is the detection of AppE. The standard analysis identified endometriosis in 7.7% (n = 23) of appendiceal specimens, whereas the modified analysis identified endometriosis in 10.0% (n = 30; odds ratio 1.3; confidence interval, 1.1-1.7; p = .01). When all pathology findings were combined, the standard analysis identified abnormal pathology in 9.3% (n = 28) of the specimens, whereas the modified analysis identified abnormal pathology in 12.3% (n = 37; odds ratio 1.4; confidence interval, 1.1-1.7; p <.01). Other abnormal appendiceal pathology identified in this study included polyps, neuroendocrine tumors, and acute appendicitis. The average number of slides required for the standard analysis was 1.4 compared with 4.9 slides for the modified analysis. At this institution, the average increase in the cost of slide production for the modified protocol was $12.07. Modified pathologic analysis resulted in a significantly higher rate of diagnosis of endometriosis and abnormal pathology in coincidental appendectomy performed during a primary gynecologic procedure for endometriosis and/or chronic pelvic pain. The use of a standard pathologic protocol likely contributes to underdiagnosis of AppE. The implementation of a modified histopathologic protocol should be considered for improving diagnosis rates of appendiceal pathology in coincidental appendectomy specimens.

1990 Is Diagnosis of Appendix Endometriosis Dependent on Pathologic Analysis?: A Prospective Cohort Study

Study Objective To evaluate the diagnosis of appendix endometriosis in coincidental appendectomy specimens using a standard versus modified pathologic analysis. Design Prospective analysis of 300 consecutive patients who underwent coincidental appendectomy at time of a primary gynecologic procedure. Setting Academic tertiary referral hospital in the Northeastern United States. Patients or Participants Women ages 22 to 52 undergoing gynecologic surgery for the management of endometriosis or chronic pelvic pain. Interventions Each appendix specimen underwent standard pathologic analysis with three sections performed. Modified pathologic analysis, consisting of standard analysis plus serial sectioning and complete evaluation of the remainder of the appendix was then performed. Each specimen served as its own control. A pathologist, blinded to whether the abnormal pathology was identified on standard versus modified pathology, re-reviewed the slides and documented the slide set containing the abnormal pathology. Measurements and Main Results The main outcome measure is detection of appendix endometriosis. Standard analysis identified endometriosis in 7.7% (n=23) of appendix specimens whereas modified analysis identified endometriosis in 9.7% (n=29; OR 1.29, CI 1.05-1.56, p-value 0.01). When all pathology was combined, standard analysis identified abnormal pathology in 9.3% (n=28) of specimens whereas modified analysis identified abnormal pathology in 12% (n=36; OR 1.32, CI 1.09-1.61, p Conclusion Modified pathologic analysis resulted in a significantly higher diagnosis rate of endometriosis and abnormal pathology in coincidental appendectomy performed during a primary gynecologic procedure. Modified pathologic analysis was found to be affordable in this academic tertiary referral center. Implementation of a modified pathologic protocol should be considered to improve diagnosis rates of abnormal pathology in coincidental appendectomy specimens.

Risk of appendiceal endometriosis among women with deep-infiltrating endometriosis.

To determine whether deep-infiltrating endometriosis (DE) carries an increased risk of appendiceal endometriosis (AppE) as compared with superficial endometriosis or no endometriosis. In a retrospective study, data were obtained by chart review of an internal database for women who underwent coincidental appendectomy during benign gynecologic surgery between July 2009 and February 2014 at a tertiary referral center in the USA. Univariate, bivariate, and regression analyses were performed. The primary exposure was surgically documented endometriosis (DE, superficial, or no endometriosis). The primary outcome was AppE. Endometriosis was diagnosed for 151 (38.2%) of 395 women; 82 (54.3%) had DE. The prevalence of AppE was 13.2% (52/395) overall; 8 (11.6%) of 69 women with superficial endometriosis and 32 (39.0%) of 82 with DE were affected. Frequency of AppE was increased among women with DE, abnormal appendix appearance, and surgical indication (all P<0.001). Women with DE had a 5.9-fold (95% confidence interval [CI] 2.9-11.9) higher risk of AppE compared with women without endometriosis, controlling for appendiceal appearance and surgical indication, and a 2.7-fold (95% CI 1.2-6.2) higher risk of AppE compared with those with superficial endometriosis. Women with DE have increased risk of AppE. Coincidental appendectomy should form part of complete endometriosis excision for these patients.

The Use of a Robotic Stapling Device for Coincidental Appendectomy

Abstract Background: Coincidental appendectomy has been shown to be beneficial in numerous patient populations. Previous reports have noted that laparoscopic surgical staplers used at the time of gynecologic surgery allow for simple, rapid removal of the appendix with decreased procedure time and no spillage of appendiceal contents into the peritoneal cavity. The use of a robotic stapler will provide the same benefits and eliminate the need for the surgeon to rely on conventional laparoscopy to complete the appendectomy. Materials and Methods: The robotic stapling device is a reusable, wristed stapling instrument that delivers six rows of staples with transection down the middle of the staple lines. This stapler was used to complete coincidental appendectomies, using the same surgical technique, in 10 patients undergoing primary gynecologic surgery. The surgical and pathologic outcomes were evaluated. Results: All appendectomies were successfully performed by the console surgeon without assistance. There ...

Robotic Stapler for Coincidental Appendectomy

Robotic Stapler for Coincidental Appendectomy

Prophylactic Appendectomy during Laparoscopic Surgery for Other Conditions.

Acute appendicitis remains the most common surgical emergency. Laparoscopy has gained increasing favor as a method of both investigating right iliac fossa pain and treating the finding of appendicitis. A question arises: what to do with an apparent healthy appendix discovered during laparoscopic surgery for other pathology. We present a case of unilateral hydroureteronephrosis complicated with rupture of the renal pelvis, due to gangrenous appendicitis with abscess of the right iliopsoas muscle and periappendicular inflammation in a 67-year-old woman, who underwent laparoscopic right annessiectomy for right ovarian cyst few years earlier, in which a healthy appendix was left inside. There is a lack of consensus in the literature about what to do with a normal appendix. The main argument for removing an apparently normal appendix is that endoluminal appendicitis may not be recognized during surgery, leading to concern that an abnormal appendix is left in place. Because of a lack of evidence from randomized trials, it remains unclear whether the benefits of routine elective coincidental appendectomy outweigh the costs and risks of morbidity associated with this prophylactic procedure. Nevertheless, it appears, from limited data, that women aged 35 years and under benefit most from elective coincidental appendectomy.

The Role of Elective Coincidental Laparoscopic Appendectomy at Time of Operative Laparoscopy in Patients with Endometriosis: A Review of Our Experience at a Teaching Institution

Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. It can affect any organ in the peritoneal cavity including the appendix. The incidence of appendiceal endometriosis in the literature is 0.8-22% [1]. Elective coincidental appendectomy is the removal of the appendix at the time of another surgical procedure unrelated to appreciable appendiceal pathology [2]. ACOG reports a potential benefit in performing an elective coincidental appendectomy in patients undergoing gynecologic procedures for pelvic pain or endometriosis secondary to potential for future appendiceal complications related to these disorders.

Elective Appendectomy at the Time of Cesarean Delivery: A Randomized Controlled Trial

Pearce, C.; Torres, C.; Stallings, S.; Adair, D.; Kipikasa, J.; Briery, C.; Fody, E. Author Information

Elective Appendectomy at the Time of Cesarean Delivery: A Randomized Controlled Trial

Elective coincidental appendectomy at the time of cesarean delivery is controversial because of concerns for infection, increased operating time and other morbidity. The risks of incidental appendectomy must be considered in light of risk of morbidity from unrecognized appendicitis. There are limited data from well-controlled studies for and against this procedure at time of cesarean delivery. This randomized, controlled trial compared postoperative morbidity in 93 women who underwent cesarean delivery with and without elective appendectomy in the years 2002-2006. The two groups evaluated included 45 study subjects and 48 controls. The primary measured outcomes were morbidity markers and operative times. The secondary outcome was the rate of appendiceal pathologic condition. Nothing in the patients history or physical examination suggested appendicitis. Among women in the study group operating time was increased by 8.8 minutes (P ≤.028). Postoperative morbidity findings in the two groups were similar. There was no significant difference in the number of hospitalized days after delivery, febrile morbidity, or mean postpartum maximum temperature. Pathologic examination revealed a high rate of occult disease in this study population: Nine of the 45 specimens were abnormal (20%), which included 2 cases of acute appendicitis. No wound complications were noted in the study group, but rate of follow-up was low. The investigators conclude from these findings that appendectomy at the time of cesarean delivery does not increase inpatient maternal morbidity and can be performed safely in selected patients.

Four Percent of Patients Undergoing Colorectal Cancer Surgery may have Synchronous Appendiceal Neoplasia

An individual with colorectal cancer has a 3 percent risk of synchronous colonic neoplasia and further 2 to 3 percent risk of metachronous cancer, a risk that has prompted colonic surveillance. The appendix has a similar mucosal pattern to the colon and it has been hypothesized that appendicular adenocarcinoma may account for 1 percent of all colorectal malignancies. A special interest of the senior author in appendiceal and rectal cancer has prompted routine removal of the appendix in all cases undergoing surgery for colorectal cancer. Consecutive patients undergoing left colectomy or anterior resection for colorectal cancer had coincidental appendectomy with the specimen pathologically analyzed. A retrospective review of the case notes and histopathology was performed. Data also were collected for patients who had right hemicolectomy for colonic carcinoma. In total, 169 patients under the care of a single surgeon had colorectal cancer resection between April 2002 and April 2005: 63 patients had right hemicolectomy, 29 had left hemicolectomy, and 77 had rectal cancer resection. Seven of 169 appendices had abnormalities: 3 mucinous cystadenomas, 2 cystadenocarcinomas, 1 carcinoid tumor, and 1 villous adenoma. Patients having colorectal cancer resection for adenocarcinoma should have appendicectomy performed. Synchronous pathology was found in 4.1 percent in this series. Metachronous neoplasia is a risk in the retained appendix in patients with colorectal cancer. Routine postoperative surveillance cannot assess the appendiceal mucosa, so there is little justification for not taking the opportunity to eliminate the possibility of future appendicitis or neoplasia.

ACOG Committee Opinion #323: Elective Coincidental Appendectomy

ACOG Committee Opinion #323: Elective Coincidental Appendectomy

SIMULTANEOUS RIGHT INGUINAL HERNIOPLASTY AND APPENDECTOMY.

CUSTOM and wide experience have put the seal of approval on coincidental appendectomy as a supplement to a variety of abdominal operations such as cholecystectomy, gastrectomy, and hysterectomy. Good surgical judgment, however, demands, among other things, that (1) the appendix be reasonably accessible; (2) no additional risk be incurred by the patient, whose safety may already be jeopardized by the primary surgical condition; (3) No additional incision, or extravagant extension of the primary incision be necessary for safe removal of the appendix; (4) the primary purpose and expected good results of the main operation be not interfered with or diminished, in any way, by the supplementary procedure. Often it is undeniably an advantage to be able to remove the appendix at the time of right inguinal hernioplasty. Recently, papers dealing with this subject have emphasized an approach to the appendix through the neck of the hernial sac.^1,2In the