[Short- and long-term outcomes of surgical techniques in gastrointestinal bezoar management]

Bezoars are masses formed by the accumulation of indigestible food or foreign materials within the gastrointestinal (GI) tract. This study aimed to compare the outcomes of fragmentation and milking (FM) versus enterotomy in patients with bezoarinduced GI obstruction and to evaluate these findings in the context of the literature.

This retrospective study analyzed data from 44 patients who underwent surgery for mechanical intestinal obstruction between 2009 and 2021 at our institution, in whom bezoars were identified as the etiological factor during the perioperative period. Demographic characteristics, comorbidities, history of previous abdominal surgery, localization of the bezoar, postoperative complications, and follow-up outcomes were evaluated. Patients with bezoars were divided into two groups: those who underwent FM and those who underwent enterotomy. Categorical variables were analyzed using the chi-square tests and are presented as frequencies and percentages. A p value <0.05 was considered statistically significant.

Of the patients, 25 (54.3%) were male, and the median age was 65 years (range: 56-73). Thirty patients (65.2%) underwent FM, and 16 patients (34.8%) underwent enterotomy. Severe complications (Clavien-Dindo grade IIIb-V) were observed in the enterotomy group, whereas no such complications occurred in the FM group (p=0.034). Additionally, postoperative bridal intestinal obstruction developed in six patients (37.5%) in the enterotomy group after discharge (p=0.025).

Fragmentation and milking appears to be the preferred first-line surgical approach in patients undergoing emergency surgery for bezoar-induced gastrointestinal obstruction, as it is less invasive and associated with reduced postoperative morbidity. Furthermore, FM may decrease the risk of postoperative obstruction compared with the enterotomy technique.