NEW YORK (Reuters Health) – Elective appendectomy performed at the time of cesarean delivery does not increase inpatient morbidity, according to results of a randomized controlled trial.

“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,” the study team concludes in the November issue of the American Journal of Obstetrics and Gynecology. Appropriate candidates include “women with palpable fecaliths and/or an abnormal appearing appendix, a history of pelvic pain, endometriosis, or anticipated intraabdominal adhesions.”

Incidental appendectomy at the time of cesarean section is controversial, Dr. Christy Pearce and colleagues note in their report. Some small, retrospective or uncontrolled studies have suggested an increased risk of maternal infection and complications, they explain.

The aim of the current study, they say, was to “provide a needed current randomized controlled trial on this topic.”

After careful explanation of the aim and design of the study, 93 pregnant women requiring cesarean delivery were enrolled in the trial. 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 c-section/appendectomy group and only in the control group if warranted.

Performing appendectomy increased operative time by only 8.8 minutes, and it was not associated with an increase in morbidity, according to the team.

The researchers also note that pathologic examination of the removed appendices revealed “a high rate of occult disease in this population of women.” Specifically, they found nine abnormalities that included acute appendicitis in two patients.

“It is not our aim to argue the wisdom of prophylactic appendectomies in all patients with cesarean delivery,” Dr. Pearce and colleagues write. “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.”

Reference:
Am J Obstet Gynecol 2008;199:491.e1-e5.