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Simplified technique for retrieval of large trichobezoars in children
Thomas P Cundy1, Ewan M Brownlee2, Day Way Goh1
1Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia.
Insights
This study introduces a less invasive mini-laparotomy technique for removing large gastric trichobezoars. The novel approach offers secure access, reduced operating time, and better wound protection, simplifying surgical management of these hairball masses.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Trichobezoars, indigestible hair masses, commonly present late in children due to slow formation.
- Surgical intervention is often necessary for established trichobezoars.
- Traditional surgical removal involves a significant laparotomy.
Abstract:
Trichobezoars are concentrations of indigestible hair or hair-like fibres within the proximal intestinal tract. In children, delayed presentation with large bezoar masses is not unusual as bezoar formation is an indolent process that takes many months or years before becoming symptomatic. Surgical management is challenging and becomes inevitable once a trichobezoar becomes more established. The standard approach involves a sizeable transverse or midline laparotomy. We describe a less invasive technique for extraction of large gastric trichobezoars via a mini-laparotomy. The key aspect to this technique involves insertion of an Alexis O Wound Protector/Retractor (Applied Medical, Rancho Santa Margarita, California, USA) into the stomach following creation of a secure temporary gastrostomy by hitching gastrotomy edges to the abdominal wall. This simplified approach has advantages of (1) secure and excellent direct intragastric access, (2) shorter operating time and (3) reliable protection of both the wound edges and peritoneal cavity from bezoar contamination.