Clinicopathological analysis of Laparoscopically Removed Appendices of Nineteen Patients with Endometriosis

Objective: Considered to be a cause of unexplained chronic pelvic pain, appendiceal endometriosis is relatively rare, accounting for only 3% of all pathologic lesions of this disorder. In this study, we analyzed the clinicopathologic findings of resected appendices with an abnormal appearance discovered during laparoscopic surgery for endometriosis.Patients and Methods: We performed laparoscopic surgery on 309 patients with endometriosis between January 2006 and December 2008 in Hokkaido University Hospital and its affiliated hospitals. Nineteen patients underwent laparoscopic appendectomy after careful pathologic inspection of their appendices.Results: An abnormal appendiceal appearance was found in 17 of 19 patients; the remaining 2 patients possessed no superficial appendiceal abnormalities but had chronic pelvic pein. Of 17 cases with abnormal appendiceal appearance, 16 (94.1%) had pathological abnormalities: appendiceal endometriosis was found in 12 cases and appendicitis in 4 cases. Two patients affected by chronic pelvic pain with normal appendiceal appearances had appendices with no pathological abnormalities. The prevalence of appendiceal endometriosis in this study was 3.9% (12/309). All patients with appendiceal endometriosis had endometriomas. Neither conversion to open surgery nor treatment for surgical complication was necessary.Conclusion: Laparoscopic appendectomy is an appropriate procedure for patients with endometriosis if they have abnormal appendiceal appearances. During laparoscopic surgery for endometriosis, especially in the case of endometrioma, close observation of the appendix may allow surgeons to remove endometriotic lesions more thoroughly.