- Email: [email protected]
Incidental appendectomy during gynecological surgery
International Journal of Gynecology & Obstetrics 59 Ž1997. 261]262
Brief communication
Incidental appendectomy during gynecological surgery C.B. Lynch a,U , P. Sinhab , S. Jalloh c a
Department of Obstetrics and Gynecology, Milton Keynes General Hospital, Milton Keynes, United Kingdom b Department of Obstetrics and Gynecology, Jessop Hospital for Women, Sheffield, United Kingdom c Department of Histo-pathology, Milton Keynes General Hospital, Milton Keynes, United Kingdom Received 17 March 1997; received in revised form 19 August 1997; accepted 2 September 1997
Keywords: Incidental appendectomy; Gynecological surgery
Claudius Amyland performed the first incidental appendectomy. He removed an inflamed appendix through a hernial sac of a 7-year-old boy w1x. Incidental appendectomy is not a common procedure during gynecological surgery due to fear of infection, morbidity and mortality. Approximately one in 800 over the age of 40 may die from appendicitis w2x. The appendix is a pelvic organ; in 30% of cases, salpingitis is a realistic complication of an inflamed pelvic appendix and further threatens viability and functional capacity of the fallopian tubes. This may lead to chronic pelvic pain and adhesions. This diagnosis and management of appendicitis in pregnancy can be very difficult and can be associated with a high maternal and fetal morbidity and mortality. We present a retrospectively analyzed data over 8 years of incidental appendectomy Žstudy group. compared with routine procedures without appendectomy Žcontrol group..
U
Corresponding author. Tel.: q44 1908 617449.
A total of 130 appendectomies were performed for benign conditions. The age range was between 18 and 50 years with a mean age of 35 in both groups. Our criteria for appendectomy were adhesions, obstruction Žfecolith., congestion and ‘inflammation’ on macroscopic examination of the appendix. In both groups, the patients presented with a history of pelvic or right iliac fossa pain in association with other gynecological pathology. The result revealed a large percentage of pathological features ŽTable 1.. There was no significant morbidity and no mortality in both groups. The symptoms in 90% of the patients in the study group Ž117r130. disappeared postoperatively. Follow-up assessment showed no recurrence of pelvic or right iliac fossa pain, whilst in the control group only 64r130 reported improved symptoms. The pain was better in only 50% of cases in this group. Opinion regarding the advisability of incidental appendectomy during other operations is not unanimous. Our observations suggest no significant increase in the total operative time or hospi-
0020-7292r97r$17.00 Q 1997 International Federation of Gynecology and Obstetrics PII S0020-7292Ž97.00215-4
262
C.B. Lynch et al. r International Journal of Gynecology & Obstetrics 59 (1997) 261]262
Table 1 Types of surgery during which appendectomy was performed
TAH BSO Division of adhesions Ovarian cystectomy Myomectomy
Study group Ž n.
Control group Ž n.
Histopathology
Study group Ž%.
62 27 11 20 10
78 22 8 12 10
Normal Chronic obstructive appendicitis Endometriosis Granuloma Enterobious vermicularis Mucocele
29 54 8.5 3.9 3.5 1.5
TAH, total abdominal hysterectomy; BSO, bilateral salpingectomy.
tal stay. Some of the excised appendices show evidence of concurrent or antecedent pathology. Acute appendicitis in 80% of cases are due to fecolith obstruction to its lumen. In our series chronic obstruction was found in over 50% of cases and the age group is in keeping with published data w3x. Because the appendix is a pelvic organ, in 30% of cases female patients are theoretically at risk. There are no data to explain how vulnerable these patients are both in the fertility age group and during pregnancy. There have been no published data regarding the need for elective appendectomy during gynecological surgery. Also macroscopic observations at gynecological surgery are rarely recorded. It is reasonable to emphasize the need to examine the appendix at gynecological surgery and if suspicious it should be removed. The results of our studies suggest that the appendix should be removed if macroscopically abnormal. It is probable that some abnormalities we have described in this brief communication would necessarily have proceeded to catastrophic consequences.
We conclude that incidental appendectomy is safe. The pathology can be surprising and the cure of presenting symptoms of right iliac fossarpelvic pain is significant. However, appropriate counseling and consent is essential in the management of such patients. We recommend that the appendix should be examined at all times at laparotomy for fear of missing an incidental pathology and selective appendectomy.
References
w1x Mann CV, Russell RCC. Bailey and Love’s short practice of surgery, 21st ed. London: Chapman and Hall 1992, pp. 1195]1215. w2x Cuschieri A, Giles GR, Moossa AR. Essential surgical practice. 2nd ed. Butterworth Heinman 1988:1161]1163. w3x Adams JT. Appendectomy for acute appendicitis: Drainage of appendiceal abscess. In: Nyhus LM, editor. Master of surgery. Philadelphia: Lippincott-Rowen 1984:114]920.
Brief communication
Incidental appendectomy during gynecological surgery C.B. Lynch a,U , P. Sinhab , S. Jalloh c a
Department of Obstetrics and Gynecology, Milton Keynes General Hospital, Milton Keynes, United Kingdom b Department of Obstetrics and Gynecology, Jessop Hospital for Women, Sheffield, United Kingdom c Department of Histo-pathology, Milton Keynes General Hospital, Milton Keynes, United Kingdom Received 17 March 1997; received in revised form 19 August 1997; accepted 2 September 1997
Keywords: Incidental appendectomy; Gynecological surgery
Claudius Amyland performed the first incidental appendectomy. He removed an inflamed appendix through a hernial sac of a 7-year-old boy w1x. Incidental appendectomy is not a common procedure during gynecological surgery due to fear of infection, morbidity and mortality. Approximately one in 800 over the age of 40 may die from appendicitis w2x. The appendix is a pelvic organ; in 30% of cases, salpingitis is a realistic complication of an inflamed pelvic appendix and further threatens viability and functional capacity of the fallopian tubes. This may lead to chronic pelvic pain and adhesions. This diagnosis and management of appendicitis in pregnancy can be very difficult and can be associated with a high maternal and fetal morbidity and mortality. We present a retrospectively analyzed data over 8 years of incidental appendectomy Žstudy group. compared with routine procedures without appendectomy Žcontrol group..
U
Corresponding author. Tel.: q44 1908 617449.
A total of 130 appendectomies were performed for benign conditions. The age range was between 18 and 50 years with a mean age of 35 in both groups. Our criteria for appendectomy were adhesions, obstruction Žfecolith., congestion and ‘inflammation’ on macroscopic examination of the appendix. In both groups, the patients presented with a history of pelvic or right iliac fossa pain in association with other gynecological pathology. The result revealed a large percentage of pathological features ŽTable 1.. There was no significant morbidity and no mortality in both groups. The symptoms in 90% of the patients in the study group Ž117r130. disappeared postoperatively. Follow-up assessment showed no recurrence of pelvic or right iliac fossa pain, whilst in the control group only 64r130 reported improved symptoms. The pain was better in only 50% of cases in this group. Opinion regarding the advisability of incidental appendectomy during other operations is not unanimous. Our observations suggest no significant increase in the total operative time or hospi-
0020-7292r97r$17.00 Q 1997 International Federation of Gynecology and Obstetrics PII S0020-7292Ž97.00215-4
262
C.B. Lynch et al. r International Journal of Gynecology & Obstetrics 59 (1997) 261]262
Table 1 Types of surgery during which appendectomy was performed
TAH BSO Division of adhesions Ovarian cystectomy Myomectomy
Study group Ž n.
Control group Ž n.
Histopathology
Study group Ž%.
62 27 11 20 10
78 22 8 12 10
Normal Chronic obstructive appendicitis Endometriosis Granuloma Enterobious vermicularis Mucocele
29 54 8.5 3.9 3.5 1.5
TAH, total abdominal hysterectomy; BSO, bilateral salpingectomy.
tal stay. Some of the excised appendices show evidence of concurrent or antecedent pathology. Acute appendicitis in 80% of cases are due to fecolith obstruction to its lumen. In our series chronic obstruction was found in over 50% of cases and the age group is in keeping with published data w3x. Because the appendix is a pelvic organ, in 30% of cases female patients are theoretically at risk. There are no data to explain how vulnerable these patients are both in the fertility age group and during pregnancy. There have been no published data regarding the need for elective appendectomy during gynecological surgery. Also macroscopic observations at gynecological surgery are rarely recorded. It is reasonable to emphasize the need to examine the appendix at gynecological surgery and if suspicious it should be removed. The results of our studies suggest that the appendix should be removed if macroscopically abnormal. It is probable that some abnormalities we have described in this brief communication would necessarily have proceeded to catastrophic consequences.
We conclude that incidental appendectomy is safe. The pathology can be surprising and the cure of presenting symptoms of right iliac fossarpelvic pain is significant. However, appropriate counseling and consent is essential in the management of such patients. We recommend that the appendix should be examined at all times at laparotomy for fear of missing an incidental pathology and selective appendectomy.
References
w1x Mann CV, Russell RCC. Bailey and Love’s short practice of surgery, 21st ed. London: Chapman and Hall 1992, pp. 1195]1215. w2x Cuschieri A, Giles GR, Moossa AR. Essential surgical practice. 2nd ed. Butterworth Heinman 1988:1161]1163. w3x Adams JT. Appendectomy for acute appendicitis: Drainage of appendiceal abscess. In: Nyhus LM, editor. Master of surgery. Philadelphia: Lippincott-Rowen 1984:114]920.