Evaluating the Risk of Postoperative Complications Following Concomitant Appendectomy During Laparoscopic Endometriosis Excision

INTRODUCTION: Endometriosis affects approximately 10% of reproductive-aged individuals and may involve the appendix in up to 30% of cases [1–3]. Appendectomy at the time of surgical management can reveal occult pathology even in normal-appearing appendices and may improve pain outcomes in patients with chronic pelvic pain [6–9]. While prior retrospective studies have suggested the safety of opportunistic appendectomy [12,13], more recent national database analyses reported higher complication rates when performed during benign gynecologic surgery [14]. Few studies, however, have focused specifically on laparoscopic excision of endometriosis, and none have systematically excluded hysterectomy or bowel procedures. Our study addresses this gap by evaluating the safety of concomitant appendectomy in a large, homogeneous cohort with attention to clinically meaningful outcomes, including 30-day readmission. OBJECTIVE: Evaluate the risk of postoperative complications following appendectomy when performed at the time of laparoscopic excision of endometriosis. METHODS: We compared patients with and without concomitant appendectomy at the time of laparoscopic endometriosis excision. The primary outcome was the incidence of postoperative complications within 30 days. Secondary outcomes included total operative time, length of hospital stay, and hospital readmission. Postoperative complications were stratified using the Clavien–Dindo classification. RESULTS: A total of 1,222 patients undergoing laparoscopic excision of endometriosis were included, of which 419 (34.3%) underwent concomitant appendectomy and 803 (65.7%) did not. Patients in the appendectomy group were younger (mean age 32.1 vs 34.3 years) and more likely to report pelvic pain as a surgical indication. They also had higher rates of advanced-stage endometriosis (AAGL Stage III/IV: 46.3% vs 36.0%; p=.001). Operative time was significantly longer in the appendectomy group (117.9 vs 107.1 minutes; p=.015), but estimated blood loss and length of hospital stay did not differ. Readmission within 30 days was also higher in the appendectomy group (13 vs 8; p=0.01). While minor complications were similar, major complications were more frequent in the appendectomy cohort (9 vs 3; p=0.005), primarily driven by higher reoperation rates (6 vs 1; p=0.008) and rate of pelvic abscesses (7 vs 1, p=.01). After adjusting for confounders, however, there was no significant difference in the overall risk of postoperative complications between the groups. The difference in readmission rates remained significant. CONCLUSIONS: Concomitant appendectomy during laparoscopic excision of endometriosis is generally safe with respect to overall postoperative complications but was associated with increased 30-day readmissions. This may be related to the higher baseline rate of advanced disease by AAGL staging observed in the appendectomy group, as patients with more advanced disease are inherently at greater risk for postoperative symptoms, complications, and healthcare utilization. Ultimately, these findings suggest that concomitant appendectomy should be considered selectively. Especially in a population at risk for chronic pain and high rates of reoperation at baseline, clinicians should weigh potential clinical benefits against the risk of increased surgical morbidity.Table 1Table 2Table 3