"Incidentaloma" as Occasional Finding During Laparoscopic Surgery: How Laparoscopy Makes The Difference!

In the scientific nomenclature, "incidentaloma" is the medical term to describe incidentally found asymptomatic tumors. We adapted the term "incidentaloma" to describe the finding of additional pathology during laparoscopic surgery conducted for a different indication. This study aimed to highlight the role of laparoscopy in identifying and addressing hidden concurrent conditions, thereby preventing the need for further surgical interventions.

Five hundred ninety-five patients undergoing laparoscopic procedures from January 2018 to January 2023 were enrolled. Patients were divided in 4 groups according to the primary pathology or anatomical district: G1 included 331 children undergoing unilateral inguinal hernia laparoscopic repair, G2 included 115 children receiving laparoscopic varicocelectomy, G3 included 40 children undergoing laparoscopic exploration for non-palpable testis, G4 included 109 children undergoing laparoscopic abdominal procedures (53 appendectomies, 10 ovarian cystectomies, 14 renal surgeries, 28 cholecystectomies, 4 esophageal surgeries).

A total of 170 incidentalomas were found intraoperatively (28.6%). In G1, 126/331 (38.1%) had contralateral patent peritoneal-vaginal duct (PPVD), and 2/331 (0.6%) had ovarian cyst (n = 1) and paratubaric cyst (n = 1). In G2, incidentaloma was found in 2/115 (1.7%), including PPVD (n = 1) and omphalomesenteric duct remnant (n = 1). In G3, PPVD was discovered in 11/40 (27.5%). In G4, 19/109 (17.4%) concomitant adnexal pathologies, 4/109 (3.7%) PPVD, 2/109 (1.8%) pelvic masses, 2/109 (1.8%) subhepatic appendices, 1/109 (0.9%) Meckel's diverticulum, 1/109 (0.9%) urachal sinus were discovered intraoperatively. The incidentalomas were treated during the same surgeries in 168/170 cases (98.8%). The postoperative course was uneventful in all patients, and no postoperative complications were observed.

Laparoscopy may be helpful to detect intraoperatively concomitant asymptomatic and unknown pathologies. Our results demonstrated that the incidence of incidentalomas was not negligible (28.6%) in the pediatric population. Laparoscopy allows their early treatment in most cases, thereby preventing the need for reintervention or emergency operation in case of acute onset.