Page 59 - World Journal of Laparoscopic Surgery

Role of Laparoscopy in Gastric Trichobezoar
This procedure involves the placement of infraumbilical port with clInIcAl sIgnIfIcAnce
an extended skin incision. The anterior wall of the stomach is fixed
to the skin on the perimeter of the wound to prevent the spillage of While planning for laparoscopic removal of trichobezoar, one
contents into the peritoneal cavity. Anterior gastrotomy is made and should have a preoperative assessment about the size of the
trichobezoar is pulled out piecemeal or in fragments without causing bezoar. The laparoscopic approach or its modifications should be
any contamination. The gastrotomy is then closed in two layers after planned taking into consideration, the size of the bezoar and also
releasing the seromuscular attachment to the abdominal wall. 1 the condition of the child to tolerate the duration of surgery and
1
Javed et al. who used this technique in three cases with an anesthesia. Due precautions should be taken to avoid any peritoneal
incision of 4 to 5 cm reported excellent outcomes with average or wound contamination.
duration of the procedure being 45 minutes. Similar technique
6
was used by Iftikhar et al. in two cases in which a small umbilical references
incision of 1.5 cm was used to remove a bezoar of size more than 1. Javed A, Agarwal AK. A modified minimally invasive technique for
10 cm. Although the size of the incision was similar or even less the surgical management of large trichobezoars. J Min Access Surg
than what has been used in laparoscopic-assisted procedures, a 2013;9:42–44. DOI: 10.4103/0972-9941.107142.
temporary gastrostomy minimizes the contamination and also 2. Nirasawa Y, Mori T, Ito Y, et al. Laparoscopic removal of a large gastric
10
reduces the duration of the procedure. Tudor et al. recommended trichobezoar. J Pediatr Surg 1998;33:663–635. DOI: 10.1016/s0022-
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running suture while fixing the stomach to the anterior abdominal 3. Cintolo J, Telem DA, Divino CM, et al. Laparoscopic removal of a large
wall along with the use of the Alexis device which provides extra gastric trichobezoar in a 4-year-old girl. JSLS 2009;13:608–611. DOI:
protection and also prevents trauma to the gastric mucosa. This 10.4293/108680809X12589999538110.
technique definitely seems to be promising as it requires no 4. Vepakomma D, Alladi A. Complete laparoscopic removal of a
laparoscopic handling of bezoar and so the risk of peritoneal and gastric trichobezoar. J Minim Access Surg 2014;10(3):154–156. DOI:
wound contamination is minimal. The duration of surgery is less 10.4103/0972-9941.134880.
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Laparoscopy or laparoscopy-assisted procedures are safe and
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feasible options in pediatric and adolescent age-group. In view 7. Hernández-Peredo-Rezk G, Escárcega-Fujigaki P, Campillo-Ojeda ZV,
of the rarity of the problem, laparoscopic skills are hard to acquire et al. Trichobezoar can be treated laparoscopically. J Laparoendosc
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surgeons. Despite its challenges, modifying and individualizing 8. Dorn HF, Gillick JL, Stringel G. Laparoscopic intragastric removal of
the technique definitely helps in improving the outcome. The giant trichobezoar. JSLS 2010;14:259–262. DOI: 10.4293/108680810X
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no contamination. At the same time, the procedure should not 9. Kanetaka K, Azuma T, Ito S, et al. Two-channel method for retrieval
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laparoscopic skills, size of the patient, the size of the bezoar, and 10. Tudor ECG, Clark MC. Laparoscopic-assisted removal of gastric
the condition of the patient are important factors in deciding the trichobezoar; a novel technique to reduce operative complications
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60 World Journal of Laparoscopic Surgery, Volume 14 Issue 1 (January–April 2021)