Laparoscopic Intra-gastric Surgery Using an X-Gate^® for a Gastric Trichobezoar in a Child

Abstract

Several types of bezoars, including diospyrobezoars and trichobezoars, have been reported. Among them, trichobezoar is most common in children, and most children with a trichobezoar undergo laparotomy for removal. We herein report on the use of laparoscopic intra-gastric surgery employing an X-Gate^® for a child with a gastric trichobezoar. A 13-year-old female was admitted to our department due to an abdominal mass and stomachache. A CT scan and endoscopy revealed two trichobezoars in the stomach and jejunum; they were 18 and 8 cm in diameter, respectively. Because endoscopic removal of these trichobezoars was impossible, we attempted laparoscopic intra-gastric surgery using an X-Gate^® from an umbilical wound made in the stomach; the gastric trichobezoar was successfully removed. After closing the gastric wall, we cut the jejunum wall with the single port surgical technique using the X Gate^®, and collected the jejunal trichobezoar in a bag. It was removed via the umbilical wound attached to the X-Gate^®. The total weight of the bezoars was 554 g. The removal of the gastric trichobezoars took only one hour and 47 minutes. Our technique shortens the operation, and is superior to the conventional operation in terms of the cosmetic results. This approach could be a very useful technique for the removal of gastric trichobezoars.