Laparoscopic appendectomy in children with Enterobius vermicularis.

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Gastrointestinal Parasitology

Background:

• Laparoscopic appendectomy is increasingly utilized in pediatric surgery due to benefits like improved cosmesis and faster recovery.
• Enterobius vermicularis (pinworms) are common in children and can cause appendiceal inflammation, complicating diagnosis.
• The endo-loop technique is a standard method for laparoscopic appendectomy in our institution.

Observation:

• During laparoscopic appendectomy using the endo-loop technique in three pediatric patients with Enterobius vermicularis, pinworms were released into the abdominal cavity.
• The worms became free after the appendix was divided between the loop ligatures.
• This intra-abdominal release of pinworms during laparoscopic appendectomy has not been previously reported.

Findings:

• A novel complication of endo-loop laparoscopic appendectomy involves the release of Enterobius vermicularis into the peritoneal cavity.
• Bipolar coagulating forceps were effectively used to thermally desiccate the released pinworms.
• Subsequent removal of desiccated worms was achieved using a blunt grasper.

Implications:

• Surgeons employing the endo-loop technique for laparoscopic appendectomy in children should be vigilant for Enterobius vermicularis.
• Careful inspection of the appendiceal stump and meticulous thermal desiccation and removal of any released pinworms are crucial.
• This highlights the importance of adapting surgical techniques to manage unexpected findings like parasitic infections during minimally invasive procedures.