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174
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Table 16.1 Types, procedures, aims, and rationale for prophylactic surgery of small intestines
Type
prophylactic
surgery Procedure Aim and rationale for prophylaxis Ref
Primary Hernia repair To prevent hernia-related strangulation in asymptomatic patients
Intestinal resection To prevent complications related to Meckel’s diverticulum in
Endoscopic or
surgical drainage
Endoscopic or
surgical
polypectomy
Closure of omental
or mesenteric
openings
Secondary Loop ileostomy Decompression of a distal ileoanal or ileorectal anastomosis after
Feeding
jejunostomy
Miscellaneous Permanent access
for ERCP
Intestinal
autotransplantation
with any abdominal wall hernias, which may cause intestinal
loss and merit resection
asymptomatic patients
To prevent duplication cyst related mass effect. Cyst is drained, a
partial cyst removal or fenestration may be performed
To prevent cancer development in polyposis syndromes [
To prevent internal herniation after a gastric bypass surgery for
obesity surgery
a total proctocolectomy of colectomy, or a colorectal or coloanal
anastomosis after an anterior resection
Endoscopic or surgical feeding jejunostomies are aimed to
prevent a future surgery for intestinal feeding access. Mainly
performed during any abdominal surgeries with no current and
clear indication for intestinal feeding, such as a
pancreaticoduodenectomy
To access to biliary tract for endoscopic procedures a
subcutaneous blind isolated loop of jejunum is constructed after
a roux-Y hepaticojejunostomy
[
1–3]
4–10]
[
[11, 12]
13, 14]
[15, 16]
[17–20]
21–23]
[
[
24, 25]
26]
[
Surgical procedures for primary prophylactic surgeries may include abdominal or inguinal hernia
repairs, intestinal resections, endoscopic or surgical drainage of a duplication, an abscess or a cyst,
endoscopic or surgical removal of a polyp, closure of an omental or mesenteric openings after a
major abdominal surgery. Types, surgical procedures, and aims or rationale for prophylaxis have
been reviewed in Table16.1.
16.3.1 Primary Prophylactic
Surgeries for Small Intestines
16.3.1.1 Prophylactic Hernia Repair
Abdominal wall hernias are common in our daily
surgical practice. As an historical viewpoint, diagnostic criteria and indications for hernia surgery
are clearly dened and surgical procedures are
rened and nearly standardized. Inguinal hernias
are common but incisional hernias also require
clinical and surgical endeavor to manage hernia related complications and clinical outcomes.
Almeh et al. (2019) have studied asymptomatic umbilical hernias in pediatric group [3]. In
their systematic review, they have concluded that
asymptomatic and uncomplicated umbilical hernias may be conservatively managed till 4–5years
of age. Prophylactic umbilical hernia repair may
be considered after these ages, when overall risk
is acceptable for surgery [27]. Gong etal. (2018)
have recently reported that watchful waiting for
asymptomatic or minimally symptomatic inguinal hernias may merely delay the need for surgery
[2]. Thus, even in asymptomatic inguinal hernias,
prophylactic hernia repair may be considered to
prevent future inguinal hernia related intestinal
obstruction and strangulation [28, 29]. Further
guidance may be available from international
guidelines for inguinal hernia management [30].
16 Prophylactic Surgery forSmall Intestines
175
16.3.1.2 Prophylactic Intestinal
Resections
Meckel’s diverticulum (MD) is a congenital malformation and related with life-time risk of complications [31]. Most of MD remain incidental
and may be related with gastrointestinal bleeding, intestinal obstruction, and inammation.
However, preoperative diagnosis has limitations
with imaging and requires laparotomy or laparoscopy. Complication related risk factors are
reported to be gender (male), age (younger than
40), size of diverticulum (longer than 2cm), and
macroscopic mucosal alterations observed during surgery. Segmental resection and anastomosis are the recommended procedure to minimize
residual heterotopic mucosa. McKay (2007) has
reported results of 29 cases with MD in 2007.
Ratio of symptomatic cases to asymptomatic
cases was 9/20. Male to female ratio was 16/13.
Symptomatic cases were signicantly younger
than the asymptomatic cases (Mean ± SD
ages were 34.9 ± 23.2 years compared with
64.2 ± 16.5, respectively). Twenty cases with
MD were treated with surgery and 10 of these
cases were asymptomatic. Laparoscopic segmental resections and diverticulectomies were performed and these surgical procedures were not
comparable for postoperative complications and
results. In addition, heterotopic mucosa was not
observed in the asymptomatic MD cases [32].
Pariza etal. (2011) have reported their experience with 62 MD cases [33]. Thirty MD cases
were incidental; male gender and younger age
were signicantly related with symptomatic and
complications in their series. They have reported
two cases of diverticulum tumor, an intussusception case, and a perforation case with unknown
object. Post-diverticulectomy complications
were not rare (1 in every 4 cases have been
reported to have complications) and suppuration
was the most common. Blouhos et al. (2018)
have reviewed surgical concerns on MD in adults
in 2018 [34]. They have not recommended routine resection in asymptomatic MD cases and
listed some risk factors for developing future
complications to be considered before surgery
These risk factors included patient age (younger
than 50 years), gender (male), diverticulum
length (longer than 2cm), and presence of ectopic or abnormal features within the diverticulum.
They have recommended diverticulectomy for
long and wedge resection for short MD.MoraGuzman etal. (2018) have updated their series in
2018 with 66 cases [35]. In this recent report,
they have observed three cases of neuroendocrine
tumors. To summarize, male and young patients
(younger than 40 age) with incidental MD may
be considered for routine prophylactic segmental
resection. For all cases with incidental MD
between 40 and 50years of age, prophylactic surgery should be considered on case by case conditions and risk factors. There is no specic need of
prophylactic surgery for female gender with incidental MD.However, for all cases with incidental
MD patients older than 50 should not be considered for routine prophylactic surgery for incidental MD.
16.3.1.3 Endoscopic or Surgical
Drainage
Small intestinal duplication cysts are rare clinical
entities and are commonly observed in jejunum
and ileum. Duodenal duplication cysts are relatively observed less frequently [36]. Duplication
cysts are located on the mesenteric side of gastrointestinal tract but have no luminal openings.
These cysts may contain any heterotopic mucosa
and have a muscular wall, with the same vascular
supply with the intestinal segment, which the cysts
have been adjacently located [37, 38]. Duodenal
duplication cysts are commonly located in the
second and the third portion of the duodenum and
may be related with pancreaticobiliary system [11,
36]. Gastrointestinal duplication cysts are develop-
mental abnormalities, and common in the newborn
and early childhood. However, cases after twenties
have been reported. There is no male or female
selection in demographic features [11]. Clinically
small intestinal duplication cysts may present with
mild symptoms and may be dened with imaging
studies. However, gastrointestinal bleeding, intestinal or biliary obstruction, and pancreatitis may
complicate the clinical course [39]. Heterotopic
mucosa was previously mentioned, and carcinoids
or adenocarcinoma has been related to duodenal duplication cysts [40, 41]. A small intestinal
176
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F. Yaylak and M. Özsoy
duplication cyst with symptoms or complications
merits a surgical intervention. Minimal invasive
surgery with endoscopy or laparoscopy may be
considered, and the prognosis is expected to be fair
[36]. With the use of computed tomography and
ultrasound may catch a small intestinal duplication
cyst [42]. In such situation a prophylactic surgery
may be rational approach, rather than watch and
wait. Simple drainage, total or partial cystectomy,
cyst fenestration or resections may be considered
on case by case basis accordingly [43].
16.3.1.4 Endoscopic or Surgical
Polypectomy
Small intestinal polyps or polyposis may not be
common, but duodenum is the primary site. Gaspar
et al. (2016) have outlined endoscopic interventions for both benign and precancerous duodenal
lesions [44]. Endoscopic or surgical interventions
may be indicated or considered during a surveillance of a patient with polyposis [13, 14].
16.3.1.5 Closure ofOmental or
Mesenteric Openings
After a major abdominal surgery which includes a
gastric resection, a pancreaticoduodenectomy or a
transvers colon resection, or during gastric bypass
surgery a potential defect in gastrocolic ligament,
omentum, or mesentery has been created. A potential intraperitoneal defect is known to be related
with internal herniation, small intestinal obstruction, and strangulation [15, 16]. Thus, whenever
an internal defect is created a prophylactic closure
should be performed to minimize the risk of internal herniation related complications.
16.3.2 Secondary Prophylactic
Surgeries withSmall
Intestines
16.3.2.1 Prophylactic Stoma
Formations withSmall
Intestine
Total colectomy with ileorectal anastomosis or total
proctocolectomy with ileoanal anastomosis is performed to treat colorectal polyposis or inammatory bowel disease. To prevent ileorectal or ileoanal
anastomosis, a proximal stoma formation with temporary ileostomy may be constructed. In such cases,
primary intentions will be to decompress distal anastomosis, to minimize anastomotic leakage, and to
decrease ileorectal or ileoanal stula rates and intrapelvic or intra-abdominal sepsis. Recently, Güenaga
etal. (2008) have reviewed ve randomized clinical
trials for temporary use of ileostomy or colostomy
(68 and 166in each group, respectively) for colorectal anastomosis [
“mortality, wound infection, time of stoma formation, time of stoma closure, time interval between
stoma formation and closure, stoma prolapse, stoma
retraction, parastomal hernia, parastomal stula, stenosis, necrosis, skin irritation, ileus, bowel leakage,
reoperation, patient adaptation, length of hospital
stay, colorectal anastomotic dehiscence, incisional
hernia, and postoperative bowel obstruction.” They
have concluded that only stoma prolapse was significant. For practical reasons, prophylactic ileostomy
may be considered after a colorectal anastomosis
formation. However, Gavriilidis et al. (2019) have
concluded that an ileostomy is not favored when
stoma formation and closure related complications
have been considered [
have suggested decreases morbidity rates with loop
ileostomy after anterior resection in the expense of
dehydration risk [47]. In this study, 666 LI and 397
LC were compared, a data which may reect the
surgical practice.
45]. The primary end points were
46]. Chudner et al. (2019)
16.3.2.2 Feeding Jejunostomy
Nutritional supplement may be essential after
a major abdominal surgery. Whenever possible
oral or enteral route is preferred. A temporary
supplement may be required to oral intake with
a feeding jejunostomy [21–23]. Esophagus and
gastric cancers are known to deplete the patient
nutritionally. After restoration of gastrointestinal continuity, it may take time to begin oral
intake, or additional supplement may be needed.
Feeding jejunostomy may be constructed during
the initial surgery or an endoscopic placement of
feeding catheter may be the other option.
16.3.2.3 Permanent Access forERCP
Hepaticojejunostomy may be performed after a
biliary resection for benign or malign disorders
16 Prophylactic Surgery forSmall Intestines
177
such as strictures, extrahepatic biliary lesions, or
periampullary mass. Reconstruction of hepaticojejunostomy may limit the access to biliary
tract through the upper gastrointestinal tract.
Thus, a formation of a permanent access has
been reported to help in such conditions to biliary tract. This access is achieved with subcutaneous blind isolated loop of jejunum, which is
constructed after a Roux-Y hepaticojejunostomy
[24, 25]. There is limited data for the outcomes,
but when a route to biliary tract through upper
gastrointestinal tract with an endoscope, this procedure may be considered.
16.3.3 Intestinal
Auto-Transplantation
Small intestinal transplantation has not been
reported previously as a prophylactic surgery.
It will not be a routine, but to outline the rationale of prophylactic surgery a case of intestinal auto- transplantation will be discussed in
this section. Cheng et al. (2018) have recently
reported an exvivo resection and intestinal autotransplantation [26]. The procedure was required
for a desmoid tumor removal in a patient with
familial polyposis. In this case, resection was
complicated due to vascular involvement.
However, a preemptive resection of the superior mesenteric artery shed area was planned.
Surgery was completed with resection, and autotransplantation was performed with jejunostomy.
As to say, prophylaxis may sometime require
do more now rather than tomorrow, and another
sometime do less now, and wait.
16.4 Role ofMinimal Access or
Invasive Surgery
inProphylactic Surgery
ofSmall Intestines
Abdominal surgery is a major risk factor for the
development of postoperative ileus, obstruction
development, and abdominal wall hernias [48].
However, minimal access or invasive surgery techniques may be indicated, accessible, and consid-
erable whenever possible. Some examples may
include a percutaneous drainage of an abdominal
cyst or abscess with ultrasonography guidance,
which may exclude an abdominal surgery completely [49]. Using laparoscopy or robotics to resect
a colorectal cancer has clear advantageous over
open surgery to minimize surgical complications
which may affect small intestines [50]. Endoscopic
removal of precancerous polyps or endoscopic
mucosal resections of early gastrointestinal cancers may have the same effects to minimize risk
of abdominal surgeries [51]. This section has outlined the need of the consideration of the surgical
technology as a mean of prophylactic approach to
prevent small intestinal anatomical and functional
integrity. We the authors strongly recommend
a minimal access or invasive surgery, whenever
feasible and accessible for abdominal procedures.
This approach may prevent small intestines from
surgical complications such as intra-abdominal
adhesions or abdominal wall hernias and related
intestinal complications mainly intestinal obstructions, strangulations, and intestinal resections.
16.5 Conclusion
Prophylactic surgery of small intestines is primarily needed whenever a clear risk of anatomic or
functional loss of small intestine. This risk may
arise from an inammation which may cause
bleeding, obstruction, and perforation. These
conditions may require advanced and emergent
interventions such as further intestinal resections related with severe intestinal insufciency.
Even fatality may occur. In some certain clinical
precancerous lesions, prophylactic resection of
lesion may be considered.
Small intestinal surgeries may be needed with
the intent of other prophylactic aims or rationales.
In these conditions, the aim or rationale of small
intestinal surgical procedures is not related to prevent small intestinal functions or anatomical integrity. These procedures include loop ileostomy to
decompress a distal anastomosis, a preemptive
feeding jejunostomy after a major abdominal surgery, a construction of a blind subcutaneous jejunal
loop to access a biliary anastomosis.
178
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F. Yaylak and M. Özsoy
Prophylactic small intestinal surgeries may be
performed with endoscopic, laparoscopic (even
with robotic), or open surgical techniques. Hernia
repair, resections, construction of a stoma, lysis
of adhesion, and even an auto-transplantation
may be indicated or considered as a prophylactic
procedure. Minimal access or invasive surgery
may minimize future intestinal adhesions which
are known with risk of intestinal obstructions.
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Prophylactic Appendectomy
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OsmanNuriDilek , HaldunKar ,
andTuranAcar
17
17.1 Introduction
Appendectomy is one of the most performed
abdominal operations. It is an operation performed for 285 years since Claudius Amyand
performed the rst appendectomy in 1735. The
frequency of appendectomy has been reported
between 75–135/100,000 per year [1]. It is
reported that the rate of appendicitis diagnosis
has increased by 0.5/100,000 annually since
1995 [1, 2]. The incidence of appendicitis may
differ according to age, sex, race, and socioeconomic status. It is slightly more common in men,
and the male/female ratio has been reported as
1.08 [1]. The diagnosis of appendicitis varies
periodically and is most often made in the third
quarter of the year in the summer [1]. The accuracy of the diagnosis of appendicitis varies
depending on gender, and the correct rate of diagnosis in women (78.6%) is lower than the rate of
O. N. Dilek (*)
Department of Surgery, Section of
Hepatopancreatobiliary Surgery, Izmir Kâtip Çelebi
University School of Medicine, İzmir, Turkey
e-mail: osmannuri.dilek@ikc.edu.tr
H. Kar
Department of Surgery, IKÇÜ, Atatürk Education and
Research Hospital, Izmir, Turkey
e-mail:
haldun.kar@saglik.com.tr
T. Acar
Department of Surgery, School of Medicine, Izmir
Katip Celebi University, Izmir, Turkey
e-mail: turan.acar@ikc.edu.tr
correct diagnosis in men (91.2%) [3]. An epidemiological study conducted in South Korea calculated that 16% of people were diagnosed with
appendicitis at some point in their lives, and
59.7% of whom underwent appendectomy. It has
also been stated that the reason for the appendectomy rate in South Korea to be higher than western societies may be due to the National Life
Insurance, whose scope has been extended in
recent years [1].
Appendicitis was found most frequently in the
10–14 age group in males and the 15–19 age
group (169/100,000) in females, while it was the
least (36/100,000) in the group under 5 [1, 2]. In
75–79 age group, in which appendicitis is also
common, complications have been encountered
more frequently.
In the literature, peaking in 10–19 and 74–79
age groups is dened as an M-shaped pattern [1,
4, 5]. Anderson etal. (2012) reported that the fre-
quency of lifetime appendicitis varies with age
[2]. According to this study, it was calculated as
3.2% in 20 age group, 5.5% in 40 age group,
7.2% in 60 age group, and 9% in group above
85years old [2]. In America, the rates are different, and 12% of men and 23% of women have
been found to have an appendectomy. Whites and
Hispanics were diagnosed with appendicitis
more, while those with African and Asian origins
were diagnosed less. Also, the rate of diagnosis
of appendicitis was higher, and the rate of perforated appendicitis was lower in those with comprehensive health insurance [2, 3, 6]. It is also
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2021
O. N. Dilek et al. (eds.), Prophylactic Surgery, https://doi.org/10.1007/978-3-030-66853-2_17
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known that the risk of appendicitis is lower in
communities fed a ber-rich diet [1, 7].
In the literature, 20–30% of cases in appendicitis series are perforated appendicitis, and in
epidemiological studies, the incidence of perforated appendicitis was found to be 29/100,000
[1, 2]. The risk of perforation is slightly less in
women. The perforation risk is higher in the oldest (≥85 age) and youngest (0–4 age) patient
group. Perforation was detected in 15.4% of the
cases in the 15–19 age group and 52–55% of the
patients over 85years old [1]. Interestingly, it
was found that perforation was more common in
Hispanics and Asians and people without private
insurance [2]. The period with the highest frequency of perforation was determined as winter
months (December). The rate of cases with perforated appendicitis detected in a particular hospital has decreased over time due to increased
teamwork [2].
17.2 Approach toAppendix
Problems
17.2.1 Nonsurgical Approach
forAppendicitis
There are some clinical studies on the medical
treatment of appendicitis. Studies are stating that
up to 90% of successful answers have been
obtained with antibiotic treatment, especially in
appendicitis series selected without complications [8, 9]. Hansson etal. (2009) reported that
antibiotic therapy was successful in 92.2% of
cases with antibiotic therapy in their series of
unselected patients. However, 13.9% of cases
developed recurrent appendicitis, and major
complications were seen three times more in the
appendectomy group [10]. In general, the preference of surgeons for appendicitis still favors
appendectomy.
17.2.2 Protection oftheAppendix
Some authors think that the protection of the
appendix will be benecial. “Appendiceal con-
duits” can be used in the treatment of some urological, neurological, and biliary pathologies.
The appendix has been used for the purpose of
eliminating fecal incontinence in Spina bida,
Hirschsprung’s disease, imperforate anus, and
some neurological diseases (MACE procedure),
for biliary reconstruction in choledochal cysts,
and appendico-vesicostomies (Mitrofanoff procedure) [11]. In the literature, such studies are
very few and usually in the form of a case report.
However, the use of the appendix for reconstruction has diminished due to the development of
surgical and minimally invasive techniques.
However, some suggest that the appendix be preserved due to the possibility of using it for “tubular conduit” in the future [12].
17.3 Appendectomies
The appendectomy procedure is simple and technically well-standardized surgery. Appendectomy
is performed during many procedures without
questioning whether there is an infection/pathology. In the last 20years, the appendectomy rate
has started to increase with the laparoscopic
approach due to less pain, more comfort, shorter
hospitalization, shorter postoperative ileus, and
low risk of infection, and today 74.6% of cases
are performed laparoscopically. This rate is
slightly lower (63.3%) in perforated appendicitis
[2, 13, 14].
There is no consensus about the normal appendix in laparotomies. Especially in cases of endoluminal appendicitis, it becomes more challenging
to diagnose. Some authors suggest performing an
appendectomy, even if the appendix is normallooking, in the lower right quadrant pain, the reason for which cannot be understood [2, 13, 15].
On the other hand, most of the authors recommend performing prophylactic appendectomies
before 30years of age [14].
Appendectomies, which are the valid treatment in the treatment of acute appendicitis in the
clinic, have also clinical applications in the form
of prophylactic, incidental, and interval appendectomy (Table17.1). All three applications are
for prophylactic purposes.
17 Prophylactic Appendectomy
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Table 17.1 Classication of etiologic factors for prophylactic appendectomy
Prophylactic appendectomy Incidental appendectomy
• Appendiceal masses • Metal intoxication (Hg) • Mesenteric
• Diveticular disease • FMF • Urinary diversion • Bariatric surgery
• Space travel • Fecalith
• Pole travel • Plastrone (interval) • Crohn’s disease • Negative laparotomy
• Foreign bodies • Radical cystectomy • Amyand hernia
• Parasites • Baryum meal • Ovarian pathologies • Cesarean
FMF Familial mediteranean fever, VP ventriculoperitoneal, Hg Mercury
(Appendicolith)
Malrotations • Intussusception
•
Chronic pelvic pain • Cystic brosis
•
Right colon diverticula • VP shunts for hydrocephalus
•
•
Endometriosis
lymphadenitis
• Omental tortion/
infarction
• Cytoreductive surgery • Incisional hernia repair
• Emergency sigmoidectomy
• Abdominal cocoon syndrome
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17.3.1 Incidental Appendectomy
Incidental appendectomy (IA) can be dened as
adding an appendectomy to the procedure while
performing another surgery. It is performed to
prevent appendicitis complications, probable difculties in differential diagnosis, and a second
surgery in the future. The current incision is used
for appendectomy [14]. In 1902, Kelly surveyed
80 well-known surgeons on the IA.Thirty seven
percent of surgeons reported that they routinely
perform IA, and 72% reported that they performed an appendectomy if the appendix was
attached to the surrounding tissues [3, 16]. Kelly,
who opposes IA, published this survey and its
results in JAMA in 1902, as the function of the
appendix is not yet known and will increase surgical morbidity. Appendectomy for reasons other
than appendicitis has been discussed in the literature for a long time. Inversion appendectomy,
dened in 1895 and popularized in the 1960s for
a short time, aimed to reduce the risk of infection
and congestion. It was abandoned due to impaired
blood supply of the appendix and increased risk
of necrosis and intussusception. However, some
series reporting that PA performed by the invagination method during cesarean does not negatively affect mortality and morbidity [17]. The
interval appendectomy is another form of PA,
which is performed in months after the regression
of plastron appendicitis. Interestingly, 69% of
patients undergoing appendectomy for acute
appendicitis are under 30 years of age, while
75% of patients performed IA are over 25years
of age [3, 18].
Snyder etal. (1998) reported the lifetime IA
rate as 2.9% in men and 16% in women. In male
patients, 36.6% of cases were reported to be performed during cholecystectomies, 11.8% of
bowel resections, and 4.9% during hernia operations [3]. In female patients, 45% of incidental
appendectomies were performed during hysterectomies, 37.5% during salpingo-oophorectomy,
18.4% during cholecystectomy, and 7.2% during
oophorectomy. IA is performed more (6–12
times) during gynecological operations, especially of women of reproductive age [3]. They
recommended to add appendectomy to women
under 35years of age during gynecological interventions. There is no consensus in 35–50years
old patients due to the risks associated with
appendectomy (bleeding, infection, ileus,
increased morbidity rates). It is not generally recommended over the age of 50 [3]. As the gynecological surgeries started to be performed more
laparoscopically, incidental appendectomies
were also started to be performed more. In common gynecological pathologies such as endometriosis, ovarian cyst torsions, and cyst ruptures,
the laparoscopic approach is preferred and many
gynecologists add IA to the procedure. Apart
from these, the appendix was also removed during laparotomies for different reasons
(Table17.1).
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Appendectomy is frequently added to the procedure in cases where laparoscopy is performed
to determine the chronic pelvic pain etiology. On
the other hand, the probability of negative appendectomy increases 2.5 times in women of childbearing age due to pelvic pathologies [3, 18].
Different results have been reported in the evaluation of the specimens whose histopathological
examination was performed to clarify the etiology of pelvic pain. Krone etal. (1989) reported
that 1718 (32%) appendectomy performed in the
series of 5369 gynecologic laparotomy cases. In
the histopathological evaluation of appendectomy specimens, appendix was found to be morphologically normal in 368 (21.4%) cases, acute
appendicitis in 136 (7.9%) cases, and chronic
appendicitis in 1118 (65.1%) cases, and carcinoid, mucocele and endometriosis in 96 (5.6%)
cases [19].
Endometriosis syndromes also play an important role in the etiology of chronic pelvic pain.
The coexistence of endometriosis in the appendix
varies according to the selected patient group.
Although endometriosis is rare (0.2%) in patients
with acute appendicitis, the frequency of endometriosis varies between 9.3% and 39% in the
appendix of patients with endometriosis syndrome. The rate of endometriosis in the appendix
of patients with reproductive pelvic pain has been
reported as 8.5% [18]. Appendix pathology is
detected in 30.2–59.0% of patients in this group.
Interestingly, the incidence of carcinoid tumors
in the appendix in the population was 0.3–1.0%,
while this rate was reported as 2.3–4.2% in
women of reproductive age [20]. In cases of deep
inltrative endometriosis (DIE), the risk of endometriosis in the appendix is further increased
(15.5–39.0%) [21]. IA to be performed in these
patients may have an important contribution in
eliminating possible appendix pathologies and
pelvic pain. Lynch et al. (1997) reported that pelvic pain resolved in 117 (90%) of 130 cases they
performed appendectomy for pelvic pain [22].
Appendectomy can be performed synchronously
during the gynecological intervention as well as
prophylactically in cases with subsequent diagnosis of endometriosis [18]. As a result, in one of
10 patients with endometriosis, one in 4 patients
with DIE, IA disease will be a preventive
procedure.
There are many publications stating that
appendectomy has been added to the process during malrotations (Fig.17.1), atresia, intussuscep-
tion, ovarian torsion, mesenteric lymphadenitis,
incisional hernia repair, and colon resections [13,
23]. In patients undergoing Ladd’s procedure due
a
Fig. 17.1 This picture (a) shows the case in which we underwent an appendectomy (arrow) from the left thoracotomy
(b) in a patient with intestinal malrotation and Bochdalek hernia. S spleen, C caecum (Archive of ON Dilek)
b
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