GastrointestinalThe effect of appendectomy in future tubal infertility and ectopic pregnancy: a systematic review and meta-analysis
Introduction
Acute appendicitis is thought to start with obstruction of its lumen, followed by an intraluminal inflammation and distension. This leads to the ischemic necrosis of the interior wall that may eventually cause perforation if not treated [1]. It has been postulated that the perforation that complicates appendicitis can lead to intra-abdominal infection and scarring, which can secondarily result in obstruction of the fallopian tubes and subsequently infertility [2].
The aim of this review is to summarize the best available data assessing the magnitude of association between appendectomy, whether complicated or not, and female fertility outcomes namely infertility and ectopic pregnancy. In addition, we wanted to evaluate the body of evidence supporting that link.
Section snippets
Methods
This systematic review is protocol-driven and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement [3].
Search results and included studies
The literature search yielded 350 references. Thirty abstracts met the inclusion after the initial screening, from which 19 eligible studies were selected (Fig. 1). The adjusted agreement between reviewers (kappa) averaged 0.80. We identified 19 observational studies, 9 cohorts, and 10 case-control studies; including data from 67,180 patients. Table 1 summarizes the characteristics of the included studies.
Methodological quality and risk of bias
The quality of the included studies ranges from low–moderate according to the
Discussion
We sought to answer if appendicitis, simple, or complicated is associated with future infertility in women. Although there really was a paucity of excellent data on this subject, our review points toward two main results. First, appendicitis is not significantly associated with subsequent future infertility in women. This is similar to other studies, such as Urbach et al., Andersson et al., and Forsell and Pieper, that have looked at this association, although not in a meta-analysis. Other
Conclusions
Although there is a paucity of excellent prospective studies, this systematic review and meta-analysis shows that appendectomy is significantly associated with an increased risk of ectopic pregnancy and is not significantly associated with future infertility. Appropriate prompt therapy for appendicitis and proper counseling should be given to women who present with appendicitis.
Acknowledgment
Financial support: none.
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