Appendectomy in the surgical treatment of endometriosis

To address the question of when to perform an appendectomy in the surgical treatment of endometriosis, a series of 500 consecutive appendectomies was reviewed. In 104 patients with pelvic endometriosis who were undergoing appendectomy, the appendix was a relatively common (13%) extragenital site of endometriosis. Gross inspection of the appendix is not sufficient to exclude endometriosis, as 38% of appendices with histologic evidence of endometriosis had a normal appearance. Patient age and the severity of endometriosis do not appear to be risk factors for appendiceal involvement. No increased postoperative morbidity was demonstrated in 65 patients who had an appendectomy when compared with a similar group of 60 patients who did not have an appendectomy. The study supports 1) removal of the appendix in patients undergoing noninfertility surgery for endometriosis, as a high prevalence of occult endometriosis was observed in this group; and 2) excision of an abnormal appendix in patients with endometriosis during infertility surgery although appendectomy for occult involvement is not supported in this group.