Michael S. Baggish

In the past, removal of the appendix was electively performed by gynecologists during laparotomy. Now, this practice is less commonly carried out for a variety of reasons, including medical liability risks, perceived advantage for retention of the appendix, lack of informed consent, and lack of technical know-how. Clearly, the latter two concerns can be remedied by explaining the advantages and disadvantages of the procedure to the patient preoperatively and obtaining permission for including the procedure during the proposed laparotomy. Lack of technical know-how requires that the gynecologist or resident be supervised and taught the technique of appendectomy. Obviously, the best scenario for teaching the appendectomy operation is during elective surgery. Patients who have undergone salpingostomy for tubal pregnancy, tubal reconstruction, or treatment for pelvic inflammatory disease and those who have severe adhesions are candidates for routine appendectomy. Similarly, fecoliths identified by computed axial tomography (CAT) scan or by palpation are reasonable indications for incidental appendectomy.