title: The effect of appendectomy in future tubal infertility and ectopic pregnancy: a systematic review and meta-analysis.
abstract: BACKGROUND
  Ruptured appendicitis has been implicated in causing scarring, which can lead to infertility and/or ectopic pregnancy. To assess the degree of association and the quality of evidence supporting the relation among appendectomy, female fertility outcomes, and ectopic pregnancy.
  
  
  METHODS
  We systematically searched multiple electronic databases from inception through May 2013 for randomized trials and observational studies. Reviewers working independently and in duplicate extracted the study characteristics, the quality of the included studies, and the outcomes of interest. Random effects meta-analysis was used to pool the odds ratio (OR) from the included studies.
  
  
  RESULTS
  Our meta-analysis based on seven observational studies provided evidence that previous appendectomy is not associated with increased incidence of infertility in women (OR = 1.03, 0.86-1.24, P = 0.71). This finding was further augmented by several noncomparative cohorts that discussed the same issue and reported nearly the same conclusion; however, these studies pointed toward putative negative impact of surgery for complicated appendicitis on fertility. Our second meta-analysis revealed the effect of appendectomy on ectopic pregnancy was found to be significant based on a pooled estimate from four studies (OR = 1.78, 95% confidence interval = 1.46-2.16, P < 0.0001).
  
  
  CONCLUSIONS
  Appendectomy is significantly associated with an increased risk of ectopic pregnancy but not significantly associated with future infertility in women.
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota; Center For the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Tarig
authors.initials: T
authors.lastname: Elraiyah
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Yassar
authors.initials: Y
authors.lastname: Hashim
authors.affiliation: Department of Medicine, Texas Tech University Health Science Center at Amarillo, Amarillo, Texas.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elamin
authors.affiliation: Mayo Clinic Libraries, Rochester, Minnesota.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: zarroug.abdalla@mayo.edu.
authors.forename: Abdalla E
authors.initials: AE
authors.lastname: Zarroug
mesh_terms: D001062:Appendectomy / Q000009:adverse effects* / Q000379:methods; D001064:Appendicitis / Q000601:surgery*; D001065:Appendix / Q000601:surgery; D002921:Cicatrix / Q000209:etiology*; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000209:etiology*
keywords: Appendectomy; Appendicitis; Ectopic pregnancy; Infertility