SIPES In Pediatric Appendicitis: An Unwonted Gateway to Minimally Invasive Surgery

Background: Single-incision pediatric endoscopic surgery (SIPES) is a minimally invasive technique that limits the surgical scar to a single incision, usually hidden within the umbilicus. It has been reported to give outcomes comparable to conventional multiport laparoscopy. Appendectomy is one of the most common procedures performed with this approach. We report a 10-year-old boy (33.9 kg) who presented with one day of acute, progressive abdominal pain, vomiting and loose stools, with tenderness and rebound tenderness in the right iliac fossa. Ultrasonography did not visualise the appendix but showed multiple mesenteric lymph nodes, and the radiologist’s impression was acute appendicitis with mesenteric lymphadenopathy. He underwent single-incision laparoscopic appendectomy under general anaesthesia through a 20 mm supraumbilical incision. The appendix was retrocaecal, inflamed and adherent to the caecum; it was freed from the caecum, the meso-appendix was cauterised up to the base, the base was ligated, and the appendix was excised and extracted. Recovery was uneventful, and he was discharged on post-operative day 3. Sutures were removed on day 8, and histopathology confirmed acute appendicitis. This case shows that a difficult, adherent retrocaecal appendix can be removed safely through a single incision in a child, with a good early outcome.

Keywords: single-incision, pediatric endoscopic surgery, SIPES, appendectomy, acute appendicitis, laparoscopic.