Associating the AAGL Classification System to Appendiceal Endometriosis in Patients with Endometriosis

Abstract

Objective:

This study aims to determine the association between appendiceal endometriosis in patients with confirmed endometriosis and evidence of deep endometriosis (DE) following surgical excision (i.e., via laparoscopy with and without robotic assistance) utilizing the American Association of Gynecological Laparoscopists (AAGL) endometriosis classification staging system.

Materials and Methods:

This was a retrospective chart review of women aged 18 years or older who underwent laparoscopic excision of endometriosis with concurrent appendectomy from December 2020 to March 2023 for abnormal appearance of the appendix or due to the presence of DE. Preoperative, intraoperative, and postoperative data were reviewed. Endometriosis staging was assigned per the AAGL endometriosis classification staging system.

Results:

Of 100 women who underwent excision of endometriosis with concurrent appendectomy, abnormal appendiceal pathology was found in 54/100 of specimens including fibrous obliteration 14/100, appendicitis 8/100, lymphoid hyperplasia 2/100, appendiceal neuroendocrine tumor 2/100, adhesions 2/100, fibrosis 1/100, and fecalith 1/100. There were associations to intraoperative appendiceal appearance of inflamed or dilated (p < 0.05). There were no associations between appendiceal pathology and AAGL endometriosis stage.

Conclusion:

Although findings did not demonstrate an association with appendiceal endometriosis and AAGL endometriosis stage, this study supports current literature on the appendiceal pathology encountered and the distribution of the pathology when removing the appendix at the time of endometriosis surgery.