Elective laparoscopic appendectomy in gynecologic surgery: When, why, and how

It is important to know which patient populations are at high risk for appendiceal pathology so that they can be assessed and counseled adequately prior to surgery. Among the components of patient counseling is a thorough and impartial discussion of procedural risks and benefits. Risk-benefit considerations should include the patient’s preferences so that she can be an active participant in her own health-care decisions.

Because the risks of appendectomy are minimal, and complications are rare, it is appropriate to offer elective laparoscopic appendectomy to patients scheduled to undergo benign gynecologic procedures, especially in the setting of chronic pelvic pain and endometriosis.

CASE: Resolved

The patient is counseled about the benefits and risks of laparoscopic incidental appendectomy, including the fact that it may be especially beneficial in women who have endometriosis. She consents to undergo the procedure at the time of her total laparoscopic hysterectomy.

Both procedures are performed safely, with no complications, and the patient’s immediate postoperative course is unremarkable. After one night of hospitalization, she is discharged home. The histopathologic report on the appendiceal specimen reveals endometriosis with fibrous obliteration of the lumen.

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