Carmen L Mueller, MD BScH, Timothy D Jackson, BSc MD MPH FRCSC, Todd P Penner, MD FRCSC, Allan E Okrainec, MDCM MHPE FACS FRCSC. Toronto Western Hospital, Toronto, Ontario, Canada
Ingested gastric foreign bodies rarely require surgical retrieval as >99% are successfully removed endoscopically. However, of those that do require surgical intervention, the vast majority are offered an open approach, even though the laparoscopic approach to many surgical procedures has been associated with less pain and morbidity. As a result, published literature involving the laparoscopic retrieval of large and sharp ingested gastric foreign bodies remains limited.
The aim of this retrospective case series is to demonstrate that laparoscopy is safe and effective for the removal of even large and sharp gastric foreign bodies, with excellent post-operative outcomes.
Three patients who underwent laparoscopic gastric foreign body retrieval at our academic tertiary care center within the last 15 months were retrospectively identified and their charts reviewed. Candidacy for a laparoscopic approach had been determined individually at the discretion of the surgeon involved and informed consent had been obtained. Outcomes included object type, surgical procedure, peri-operative complications, length of stay and 30-day mortality.
Two of the three patients were women, with a median age of 23 (22-80). Objects retrieved were: (a) 6.0 x 1.8 cm razor blade, (b) 3.0 x 0.2 cm calcified fish bone, and (c) 11.5 x 5.6 cm suture scissors. In all patients, the foreign body was extracted via a gastrotomy, and subsequently removed through the largest port site. All cases were successfully completed laparoscopically. None of the patients suffered a perioperative complication, and none required patient-controlled analgesia or high dose narcotics for post-operative pain control. One patient was discharged home the following day. The other two patients were medically ready for discharge by post-operative day #2 and 4 respectively, but psychosocial issues led to them being discharged on POD#4 and 7. None required readmission for peri-operative complications, and 30-day mortality was zero.
Laparoscopy is a safe and effective approach for retrieval of ingested gastric foreign bodies, and excellent post-operative outcomes can be achieved. It should be considered an alternative to laparotomy by experienced surgeons when endoscopy has failed.
Program Number: P249