Combined Cesarean Section and Appendectomy Found Safe

Elective appendectomy performed at the time of cesarean delivery does not increase inpatient morbidity, according to the results of a new study.

Researchers at the University of Tennessee (Chattanooga, USA) and Holland Hospital (Holland, MI, USA) conducted a randomized controlled trial of 93 pregnant women requiring cesarean delivery. Forty-five women were randomly assigned to cesarean delivery and appendectomy and 48 were randomly assigned to cesarean section only (the control group). Appendices were inspected in both groups and appendectomy was performed on all women in the combined c-section and appendectomy group, but in the control group only if it was found warranted. The study results showed that operative time in the study group due to the appendectomy was increased by a total of only 8.8 minutes. Postoperative morbidity findings in both groups were similar. Post-operative pathologic evaluation of the removed appendices revealed nine abnormalities that included acute appendicitis in two of the patients. The study was published in the November 2008 issue of the American Journal of Obstetrics and Gynecology (AJOG).

"Based on this and the calculated benefit of selective incidental appendectomy, we believe that appendectomy at the time of cesarean delivery can be considered safely in selected patients,” said lead author Christy Pearce, M.D., and colleagues of the department of obstetrics and gynecology at Holland Hospital. "Appropriate candidates include women with palpable fecaliths and/or an abnormal appearing appendix, a history of pelvic pain, endometriosis, or anticipated intra-abdominal adhesions.”

"It is not our aim to argue the wisdom of prophylactic appendectomies in all patients with cesarean delivery,” concluded Dr. Pearce. "However, visual inspection and palpation of the appendix at the time of cesarean delivery is a plausible guide to the identification of candidates for elective appendectomy and the enhancement of patient outcomes.”

Related Links:
University of Tennessee
Holland Hospital