11/10/2026
An Often-Overlooked Question in Gynaecological Laparoscopy: Should We Remove an Incidentally Detected Diseased Appendix?
This is a topic that deserves thoughtful discussion among gynaecologists and pelvic surgeons.
During laparoscopic surgery for chronic pelvic pain, endometriosis, PID or infertility, should we simply ignore an appendix that appears diseased, or should we evaluate it carefully and consider appendectomy when indicated?
I believe this question deserves much more attention in gynaecological surgical practice.
Appendiceal inflammation, particularly when complicated, may extend into the surrounding tissues and contribute to pelvic inflammation and adhesions. In selected cases, the right fallopian tube and adnexa may also be affected. For women who wish to preserve their future fertility, overlooking associated pelvic pathology may have consequences.
Appendiceal endometriosis is another important consideration. Published literature has demonstrated that appendiceal disease can coexist with pelvic endometriosis and may contribute to otherwise unexplained pelvic pain.
Of course, not every incidentally encountered appendix needs to be removed. The decision must depend on the operative findings, the suspected pathology, the patient’s informed consent, the potential benefits and risks, and the surgeon’s competence.
Should gynaecological laparoscopic surgeons learn appendectomy?
I believe that every gynaecological laparoscopic surgeon should at least understand the principles of appendiceal assessment, recognise abnormal findings and know how to manage them appropriately.
Laparoscopic surgeons also need a sound understanding of the recognition and initial management of complications involving adjacent organs, including the bladder and bowel, with the ability to repair selected injuries within their competence or obtain timely specialist assistance.
Appendectomy is not a substitute for comprehensive surgical training. However, for appropriately trained surgeons, it can be a valuable additional skill when a genuine indication arises during pelvic surgery.
One of the greatest advantages of laparoscopy is the opportunity to survey the abdomen and pelvis systematically. We should make use of this opportunity rather than focusing exclusively on the primary pathology for which the patient was scheduled for surgery.
A lesson from my mentor
I consider myself fortunate to have learned the fundamentals of laparoscopy from my respected senior, prof Jafrul Hannan a renowned laparoscopic surgeon and paediatric laparoscopic surgeon who has trained many surgeons.
During my basic laparoscopic training, I had the opportunity to learn hands-on surgical skills, including appendectomy, under his guidance.
At that time, I was learning because I wanted to become a better surgeon. I could not fully appreciate how useful that experience would become in my future practice.
Today, when I encounter an appropriately selected patient with a diseased appendix during gynaecological laparoscopy, that early training often proves invaluable. When the indication is clear and I can safely perform the procedure within my competence, I may be able to address an additional pathology during the same operation.
For suitable patients, this can avoid a separate operation and its associated additional anaesthesia, recovery and costs. However, these benefits depend on the clinical circumstances and should never be assumed for every patient.
Whenever I reflect on this journey, I remember my mentor with deep respect and gratitude. I pray to Allah to keep him healthy, safe and blessed.
Sometimes, we learn a skill without realising how much it will mean to our patients years later. Only with time do we understand the true value of that learning.
Alhamdulillah, I am grateful to Allah for the opportunity to learn, practise and use those skills for the benefit of my patients.
My message to fellow gynaecologists is simple:
During every laparoscopic pelvic surgery, look beyond the primary pathology. Survey the pelvis carefully, inspect the appendix when appropriate, recognise associated disease and act according to sound surgical judgement.
We may not be able to treat every associated pathology ourselves, but we should never overlook it simply because it falls outside our usual area of focus.
Good surgery is not only about completing the planned procedure. It is also about recognising what else matters for the patient—and knowing how best to help.
