Incidental appendectomy at the time of gynecologic surgery

Purpose of Investigation: This study was performed to evaluate the safety and feasibility of incidental appendectomy in a high risk gynecologic and gynecologic oncology patient population. Materials and Methods: This was a retrospective review evaluating 3,210 patients. Data reviewed included: age, preoperative diagnosis, route of surgery, procedure performed, length of stay, BMI, complications, and final diagnosis. Data was abstracted and analyzed; Mann-Whitney U and t-test were used to calculate outcomes. Significance was set at a p < 0.05 for each statistical test. Results: This study included 1,876 appendectomies that were performed at the time of gynecologic surgery. Eighty-two percent of procedures were performed laparoscopically. A high rate of abnormal pathology was identified: there were 32 (1.7%) primary appendiceal cancers identified, gynecologic cancer metastasis was identified in 71 (3.8%) patients, 12 (0.6%) patients had metastatic other cancer to the appendix, 40 (2.1%) patients had appendiceal endometriosis, and 25 (1.3%) patients had appendicitis. The total number of patients with significant appendiceal pathology was 221 (11.8%). No complications were attributed to the appendectomy procedure itself. BMI was not related to the ability to perform appendectomy (t-test, p = 0.9960), nor was route of surgery (t-test, p = 0.9256). Length of stay in the laparoscopic cohort was shorter for those who underwent appendectomy. Conclusions: Incidental appendectomy during gynecologic surgery is safe and feasible. This study documents that safety in an especially high risk gynecologic and oncologic patient cohort. This procedure can be routinely offered to address the increasing rate of acute appendicitis, occult malignancy, contribute to cancer debulking, and diagnose etiology of chronic pelvic pain in women concordant with their gynecologic surgery.

Appendectomy; Incidental; Gynecology; Cancer; Feasible; Safe.

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