Study on Endometriosis and Appendiceal Endometriosis

USA: Women with endometriosis are at increased risk of appendiceal endometriosis (AppE). The risk is greatest with stage III-IV endometriosis patients, suggests a recent study in the American Journal of Obstetrics and Gynecology. According to the authors, coincidental appendectomy should form part of complete endometriosis excision in these patients, given the high prevalence of AppE in this population.

Coincidental appendectomy has not been widely adopted as a standard of care in surgery for endometriosis and chronic pelvic pain due to uncertainty as to the prevalence of appendiceal pathology and procedure safety.

W.T. Ross, Department of Obstetrics and Gynecology, Penn State Health, Hershey, PA, and colleagues describe the rate of AppE in women having coincidental appendectomy at the time of gynecologic surgery for pelvic pain, stage I-II endometriosis, or stage III-IV endometriosis.

The researchers conducted this retrospective case series whereby data was obtained by a review of an internal database with validation of data through chart review. The women having coincidental appendectomy during surgery for endometriosis or pelvic pain were tracked. All patients were from an academic tertiary referral hospital in the Northeastern United States between March 2013 and June 2019. The analysis included 609 consecutive women.

The 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.

Key Findings of the Study

• 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), 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," concluded the authors.

The study, "Coincidental appendectomy in the surgical management of women with endometriosis and pelvic pain," is published in the American Journal of Obstetrics and Gynecology.

DOI: https://doi.org/10.1016/j.ajog.2019.12.037