Is incidental appendectomy necessary in women with ovarian endometrioma?


: Dr Joong Sub Choi, Division of Gynecological Oncology and Gynecological Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108, Pyung-dong, Jongno-gu, Seoul, South Korea. Email:


Background:  Several studies reported that pathology of the appendix is frequently detected alongside endometriosis, especially with chronic pelvic pain. Furthermore, ovarian endometriosis is a marker of more extensive pelvic and intestinal disease.

Aims:  To evaluate the feasibility and efficacy of incidental appendectomy in laparoscopic surgical treatment for ovarian endometrioma.

Methods:  One hundred and six women with ovarian endometrioma underwent laparoscopic surgery including laparoscopic appendectomy. Clinicopathological data were collected and analysed.

Results:  The main symptoms consisted of lower abdominal pain in 51 (48.1%) women, dysmenorrhoea in 23 (21.7%), left lower quadrant pain in 6 (5.7%), right lower quadrant pain in nine (8.5%), chronic pelvic pain in five (4.7%), and others in 12 (11.3%). Only three (3.3%) of the 106 women had abnormal findings on gross inspection during laparoscopic surgery: two women with endometriotic spots on the surface of their appendixes, and one with peri-appendiceal inflammation with severe adhesions. Of the 106 resected appendixes, 37 (34.9%) had histopathologically confirmed pathology including lymphoid hyperplasia in 12 (11.3%), endometriosis in 14 (13.2%), peri-appendicitis and serositis in five (4.7%), carcinoid tumour in three (2.8%), and others in three (2.8%).

Conclusions:  In all surgical treatments for ovarian endometrioma, surgeons need to preoperatively inform the patients of the fact that appendiceal pathology including endometriosis is found frequently regardless of concurrent symptoms or gross finding of the appendix. Furthermore, surgeons should take into account the possibility of appendiceal pathology during operation.