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Do Paediatric Patients with a Trichobezoar Benefit from a Modified Laparoscopic Approach? A Systematic Review
Frauke Alexandra Blaum1, Ahmad Alsweed2, Wolfgang Eberl3
1Paediatric Surgery, Städtisches Klinikum Braunschweig gGmbH, Brunswick, Germany.
Insights
This study introduces a minimally invasive surgical approach for removing gastric trichobezoars in children. This technique offers a safe and cosmetically favorable alternative to traditional laparotomy for pediatric trichobezoar removal.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Trichobezoars are rare in children, with limited evidence-based treatment guidelines.
- Surgical removal, often via laparotomy, is the predominant treatment.
- Minimally invasive options are underrepresented in current literature.
Purpose of the Study:
- To present a minimally invasive surgical strategy for pediatric gastric trichobezoars.
- To review current literature on trichobezoar management in patients aged 18 years or younger.
- To evaluate the safety and outcomes of a modified laparoscopic technique.
Main Methods:
- Literature review of PubMed-indexed articles (2016-2020) on isolated pediatric trichobezoars.
- Analysis of 41 cases from 34 publications, including two presented cases.
- Comparison of treatment modalities: laparotomy, endoscopic removal, and laparoscopic techniques.
Main Results:
- 41 pediatric trichobezoar cases identified (age 2-17 years; 7:1 female-to-male ratio).
- Laparotomy was used in 36 cases; modified laparoscopic techniques in 5.
- Purely laparoscopic extraction was successful in only 1 case.
- The presented modified minimally invasive approach resulted in uncomplicated recovery and good cosmetic results.
Conclusions:
- A modified minimally invasive approach facilitates safe and effective pediatric trichobezoar removal.
- This technique minimizes intra-abdominal contamination risk.
- It provides a favorable cosmetic outcome compared to open surgery.
Abstract:
Trichobezoars represent a rare condition in paediatric patients, and evidence-based treatment recommendations are lacking. Most reported cases describe surgical removal, predominantly by laparotomy.We present a minimally invasive surgical strategy based on two paediatric cases of gastric trichobezoars and review the current literature. A PubMed search was performed including research articles and case reports published between 2016 and 2020. Inclusion criteria were isolated trichobezoars in patients aged ≤18 years, while reports describing combined bezoars were excluded. Extracted data included age, sex distribution, clinical presentation, medical history, imaging, treatment modality, and follow-up management.Thirty-four publications comprising 41 paediatric cases of trichobezoars were identified (age range: 2-17 y; female-to-male ratio: approximately 7:1). Endoscopic removal was attempted in 10 cases, requiring conversion to laparotomy in nine cases and to a modified laparoscopic technique in one case. Overall, 36 bezoars were removed by laparotomy, 5 by a modified laparoscopic technique, and only 1 by purely laparoscopic extraction without auxiliary incision.Our modified minimally invasive approach resulted in an uncomplicated postoperative course and a favourable cosmetic outcome. The technique enables safe removal of trichobezoars while minimising the risk of intra-abdominal contamination.
