Laparoscopic appendectomy in patients with endometriosis Bulent Berker, MD, Nanette LaShay, MD, Romina Davarpanah, MD, Massimilano Marziali, MD, Ceana H. Nezhat, MD, and Camran Nezhat, MD From the Center for Special Minimally Invasive Surgery, Stanford University Medical Center, Palo Alto, California (Drs. Berker, LaShay, Davarpanah and Camran Nezhat); Nezhat Medical Center, Endometriosis Clinic, Atlanta, Georgia (Dr. Ceana Nezhat); and Stanford University Medical School, Palo Alto, California (Dr. Camran Nezhat). Abstract STUDY OBJECTIVE: To report the frequency and spectrum of histologically proved diseases of the appendix in patients undergoing laparoscopic surgery for chronic pelvic pain in conjunction with endometriosis in a tertiary referral center. DESIGN: Patient database with retrospective chart review (Canadian Task Force classification II-3). SETTING: University ambulatory endoscopic surgery center—tertiary referral center. PATIENTS: Two hundred thirty-one women. INTERVENTIONS: Appendectomy during laparoscopic surgery for endometriosis. MEASUREMENTS AND MAIN RESULTS: We reviewed the medical records of 231 patients who underwent appendectomy during laparoscopic treatment of endometriosis performed from January 1994 through July 2004. Of the 231 patients with pelvic endometriosis, concomitant appendiceal pathology was present in 115. CONCLUSION: The appendix may be involved and may contribute to pelvic pain in patients with endometriosis. © 2005 AAGL. All rights reserved. KEYWORDS: Endometriosis; Chronic pelvic pain; Appendiceal pathologies; Laparoscopic appendectomy Chronic pelvic pain (CPP) accounts for 10% of all gy- necologic office visits and approximately 50% of all gyne- cologic laparoscopies. 1,2 Although the number of disorders that may be associated with CPP is large, in clinical prac- tice, endometriosis, adhesions, irritable bowel syndrome, and interstitial cystitis are the diagnoses made most fre- quently. 3 Endometriosis-associated pelvic pain can be treated medically or surgically. Laparoscopic surgical treat- ment is particularly popular, as it can be done at the time of diagnostic laparoscopy. 3 During laparoscopy, the assump- tion that CPP is solely a result of pelvic endometriosis may be erroneous. Among other etiologies, appendiceal disease is often a possibility and should be considered in the dif- ferential diagnosis. 4 To the best of our knowledge, there are sparse data that specifically evaluate the diseases of the appendix in women with endometriosis and CPP without solely right lower quadrant (RLQ) pain. In this study, we report our experi- ence with the frequency and spectrum of histologically proved diseases of the appendix in patients undergoing laparoscopic surgery for CPP and endometriosis. Materials and methods We reviewed the medical records of 231 patients who un- derwent appendectomy during laparoscopic treatment of endometriosis performed from January 1994 through July Corresponding author: Camran Nezhat, MD, Stanford University Med- ical School, Stanford University, 900 Welch Road, Suite 403, Palo Alto, CA 94304. E-mail: cnezhat@stanford.edu. Submitted August 4, 2004; accepted for publication November 10, 2004. 1553-4650/$ -see front matter © 2005 AAGL. All rights reserved. doi:10.1016/j.jmig.2005.03.003 Journal of Minimally Invasive Gynecology (2005) 12, 206-209