Трихобезоар желудка доклад на съезде EAES 17.06.11.

LAPAROSCOPIC SINGLE INCISION ASSISTED TECHNIQUE FOR REMOVAL THE GIANT STOMACH TRICHOBEZOAR

Our patient was a 21-years old young lady with complaints of feeling the dense formation in the epigastrium. About 2 months before admission, being in the prone position, she accidentally found out by herself the induration in epigastrium area. Patient's life history taking revealed trichophagy in the childhood for several years.
The initial examination (CT scanning) revealed a giant foreign body, filling almost the entire lumen of the stomach and duodenal bulb. This was confirmed by the following upper GI endoscopy. Look at the giant stomach trichobezoar in the gastric cavity! Now you can see that its fills the whole free space of the stomach.
Given the fact that our patient was a very young woman, the desire to achieve better cosmetic results has led to search for a less invasive technique. So surgery was performed using SILS-assisted technique. Transverse 2,5 cm skin incision in suprapubic region for single port system insertion was made (Triport, Olympus). We have to insert an additional transumbilical trocar for 30 degree 5-mm rigid laparoscope in order to achieve an optimal visualisation of the operative field due to the extended size of the stomach. Gastrotomy was performed in the middle third of anterior wall of stomach using the ultrasonic scissors. Now you can see the trichobezoar. One more additional port was introduced at a distance of 3 cm from single port system in the suprapubic region. Gastrotomy was performed using suturing device in the proximal way and was continue in the distad to the antrum, using the ultrasonic scissors. The total length of gastrotomy was approximately 15 cm.
We used a largest size of EndoCatch for mass extraction, introduced through the suprapubic port. With some technical challenges the trichobezoar was removed from the stomach into EndoCatch, due to the overinflated size of bezoar, which was much bigger then container.
Gastrotomy was closed up by double-rowed interrupted sutures. After that the triport system was took out. Given the large size and high density of bezoar and unability of its fragmentation, an incision in the suprapubic region was extended up to 7 cm to make an extraction possible. The extracted specimen represented a dense compact hair lump up to 25 cm length and up to 10 cm in diameter. Now we can see bezoar, fiiling all part of the stomach (fundus, body, antrum) and the duodenal bulb.
2 drain tubes were placed in the abdominal cavity. The wound was closed up in layers with the cosmetic intradermal suturing with the total length of 7 cm.
Recovery was uneventful, subfebrile temperature was during 2 days after surgery. The drain tubes was removed on the 2nd postoperative day; the patient was discharged on the 6th day after surgery. Follow-up gastroscopy two months later showed the folds convergence in the operation area; you can see no pathological changes in gastrotomy area. And this is the skin incisional scar two weeks after surgery. You can see an excellent cosmetic result.

Category:

Science & Technology

Tags:

• SILS
• LESS
• STOMACH
• TRICHOBEZOAR