Use of Laparoscopic approach for removal of large Gastric Trichobezoar in children.

Ashwin Pimpalwar, MD, FRCS, Pediatric, surgery

Division of Pediatric Surgery, Michael E Debakey Department of Surgery, Baylor college of medicine and Texas Children’s Hospital, Houston, Texas.

Purpose: To report our technique of laparoscopic removal of large Trichobezoar in children.

Material methods: 9 year old child presented with vomiting and intolerance to oral diet. Upper GI contrast revealed the presence of a large Trichobezoar in the stomach. The Gastroenterologist took the child to the procedure room for gastroscopic removal of the trichobezoar. After several attempts they were only able to remove a bit of it and unfortunately their grasper got stuck into the bezoar. The surgeons were consulted and the patient was then moved in to the OR with the gastroscope and the grasper insitu.

Technique: A 5mm step trocar was placed as an umbilical port and 5mm 30 Deg telescope was introduced. A small 2 cm incision was made on the anterior abdominal wall and with a grasper the stomach was pulled up to the anterior abdominal wall. 2 Gastropexy sutures were then to bring the stomach to the anterior abdominal wall. A small gastrostomy was then made and the trichobezoar was then removed piecemeal. The endoscopy grasper was released from the hair ball during the procedure and the gastroscope was removed. Once the trichobezoar was completely removed the gastrostomy was closed with absorbable sutures and the stomach was returned back to the peritoneal cavity. All the ports sites were sutured closed.

Results: The child did well after surgery and was discharged. There were no intraoperative or post- operative complications. At 1 year follow up the child was doing well and the scars were well healed.

Conclusion: Laparoscopic removal of large gastric trichobezoar is safe and effective in children. It should be tried in all children before subjecting them to large laparotomy incisions.

Session: Poster Presentation

Program Number: P571

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