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Operative procedure. (A) Securing gastrotomy with stay sutures at the incision site. (B) Intragastric application of wound protector. (C) Homemade single port device using a surgical glove with 2 access ports (12 mm and 5 mm in diameter) through the glove fingers. (D) Laparoscopic removal of a gastric bezoar impacted in the pylorus. (E) Removal of impacted gastric bezoar through gastrotomy. (F) Closure of gastrotomy with linear staplers. (G) After reinforcement sutures of gastrotomy site in the peritoneal cavity. (H) A 4 cm sized supraumbilical skin incision After closure.
Source publication
Regarding the removal of a gastric bezoar, laparoscopic surgery was performed and it was shown that the laparoscopic approach is safe and feasible. However, the laparoscopic method has the risk of intraabdominal contamination, when the gastric bezoar is retrieved from the gastric lumen in the peritoneal cavity. We developed and applied a new proced...
Contexts in source publication
Context 1
... was inserted from the skin to the peritoneum to prevent the wound from contamination. The stomach was pulled out of the wound and a longitudinal gastrotomy of about 3 cm in length was made at the anterior wall of the stomach body. Around the gastrostomy site, four 3-0 silk stay sutures were made to secure the traction of the anterior gastric wall (Fig. 2A). While keeping traction of the stomach to the extra-peritoneum, another wound protector was inserted from the skin wound to the gastric lumen (Fig. 2B). A surgical glove as a homemade single port device was employed to wrap the wound protector and 2 access ports (12 mm and 5 mm in diameter) were secured with a tie to fingers of the ...Context 2
... of about 3 cm in length was made at the anterior wall of the stomach body. Around the gastrostomy site, four 3-0 silk stay sutures were made to secure the traction of the anterior gastric wall (Fig. 2A). While keeping traction of the stomach to the extra-peritoneum, another wound protector was inserted from the skin wound to the gastric lumen (Fig. 2B). A surgical glove as a homemade single port device was employed to wrap the wound protector and 2 access ports (12 mm and 5 mm in diameter) were secured with a tie to fingers of the glove. While intra-gastric pneumatic pressure was established with 12 mm Hg, a 30 degree laparoscope was inserted through the 12 mm port and the ...Context 3
... port device was employed to wrap the wound protector and 2 access ports (12 mm and 5 mm in diameter) were secured with a tie to fingers of the glove. While intra-gastric pneumatic pressure was established with 12 mm Hg, a 30 degree laparoscope was inserted through the 12 mm port and the laparoscopic instrument was introduced via the 5 mm port (Fig. ...Context 4
... the gastric bezoar was easily confirmed laparoscopi- cally to be impacted in the pylorus, endo-forceps were employed to retrieve and break up the bezoar into the stomach body (Fig. 2D). After the glove was removed, the fragment of the bezoar was directly retrieved by forceps through the gastrotomy. The content of the bezoar contained seeds of persimmon, and is considered as phytobezoar derived from persimmon. After confirming the he- mostasis of the gastric lumen, the inner side wound protector was removed (Fig. ...Context 5
... body (Fig. 2D). After the glove was removed, the fragment of the bezoar was directly retrieved by forceps through the gastrotomy. The content of the bezoar contained seeds of persimmon, and is considered as phytobezoar derived from persimmon. After confirming the he- mostasis of the gastric lumen, the inner side wound protector was removed (Fig. 2E). The gastrotomy was closed using endolinear staplers (Fig. 2F). Interrupted 3-0 silk sutures were made to the staple line for reinforcement (Fig. 2G). Then, the outer wound protector was removed and the fascial incision was closed, followed by skin closure (Fig. 2H). The total operation time was 69 ...Context 6
... of the bezoar was directly retrieved by forceps through the gastrotomy. The content of the bezoar contained seeds of persimmon, and is considered as phytobezoar derived from persimmon. After confirming the he- mostasis of the gastric lumen, the inner side wound protector was removed (Fig. 2E). The gastrotomy was closed using endolinear staplers (Fig. 2F). Interrupted 3-0 silk sutures were made to the staple line for reinforcement (Fig. 2G). Then, the outer wound protector was removed and the fascial incision was closed, followed by skin closure (Fig. 2H). The total operation time was 69 ...Context 7
... the bezoar contained seeds of persimmon, and is considered as phytobezoar derived from persimmon. After confirming the he- mostasis of the gastric lumen, the inner side wound protector was removed (Fig. 2E). The gastrotomy was closed using endolinear staplers (Fig. 2F). Interrupted 3-0 silk sutures were made to the staple line for reinforcement (Fig. 2G). Then, the outer wound protector was removed and the fascial incision was closed, followed by skin closure (Fig. 2H). The total operation time was 69 ...Context 8
... the he- mostasis of the gastric lumen, the inner side wound protector was removed (Fig. 2E). The gastrotomy was closed using endolinear staplers (Fig. 2F). Interrupted 3-0 silk sutures were made to the staple line for reinforcement (Fig. 2G). Then, the outer wound protector was removed and the fascial incision was closed, followed by skin closure (Fig. 2H). The total operation time was 69 ...Citations
... The majority of trichobezoars are removed surgically because large trichobezoars are too large to be removed endoscopically or because it takes too long to crush and remove them [1]. Historically, they have been removed by gastrostomy through a large incision; more recently, laparoscopic surgery using minimally invasive wound closure techniques with wound edge protectors such as the Alexis wound retractor (Applied Medical, Rancho Santa Margarita, California, USA) has been reported [2][3][4]. However, postoperative complications such as wound infection and intra-abdominal abscesses are still a problem [5]. ...
... Although there have been a few reports of successful complete endoscopic removal of small trichobezoars, the majority of cases prove challenging and require surgical intervention [1]. Surgical removal methods including laparotomy, laparoscopy, and intragastric surgery using wound edge protectors such as wound retractors have been reported [2,3]. A more traditional approach, laparotomy, has been widely used in the past but has had problems with surgical wound expansion and contamination [1]. ...
... Laparoscopic surgery may improve cosmetic outcomes; however, concerns remain about prolonged operative time and potential intraabdominal contamination with gastric contents [1,7,8]. Although intragastric surgery using a wound retractor is expected to minimize the surgical wound and reduce the risk of wound infection and intraabdominal contamination, postoperative wound infection remains a concern [3,4]. In this case, we employed a novel method of using two Alexis wound retractors. ...
Trichobezoars are difficult to remove endoscopically and often require surgery. We performed trans-umbilical intragastric surgery using two Alexis wound retractors with successful results in a pediatric patient with a trichobezoar. This method is a safe and cosmetically favorable option for the removal of large trichobezoars and does not require special techniques or instruments. It also contributes to the reduction of postoperative complications such as wound infection and intra-abdominal abscess.
... 10,11 Laparoscopic resection usually needs intraoperative endoscopic control to ensure adequate oncologic margins, requiring advanced laparoscopic expertise. Based on current studies of single incision intragastric surgery, [12][13][14][15][16][17] our research group has developed a method of gaining access to the stomach by means of a percutaneous intragastric single-port device, which can be indicated for different upper digestive tract lesions, as the resection of gastric intraluminal tumors or bleeding lesions, 18 to gain access to the remnant stomach and perform ERCP after RYGB, 19 and revising the pancreaticogastric anastomosis after pylorus-preserving pancreaticoduodenectomy (PPPD). ...
Background: Endoscopic treatment can represent a technical challenge for several special situations, such as resecting gastric tumors with larger size or in unfavorable sites and performing endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y gastric bypass (RYGB). This study aims to describe an innovative and multipurpose technique, intragastric single-port surgery (IGS), which can be applied for abovementioned special situations and for assessing its safety, feasibility, and efficacy. Methods: IGS technique was performed through a 2–3 cm skin incision, where the stomach wall is exteriorized and fixed to the skin. The single-port device is inserted and intragastric access is gained for laparoscopic or endoscopic instruments. Three purposes of IGS were performed: (1). gastric intraluminal lesions resection; (2). to perform ERCP after RYGB; and (3). revision of pancreaticogastric anastomosis after pylorus-preserving pancreaticoduodenectomy. Results: IGS was performed successfully in 20 patients. Ten patients underwent gastric intraluminal lesion resection, mostly for gastric gastrointestinal stromal tumors (n = 7, 70%); all pathological specimens were with negative margin, mean operation time was 102.3 ± 43.5 minutes, and mean postoperative hospital stay was 4.6 ± 1.5 days. Nine patients underwent ERCP after RYGB, cleaning of the bile duct was successful in all patients (100%), and mean operation time and mean postoperative hospital stay were 140.6 ± 46.3 minutes and 4.4 ± 2.6 days, respectively. One patient underwent pancreaticogastric anastomosis revision. There were no mortalities in our series. Conclusions: IGS is a safe, feasible, and effective technique for gastric intraluminal lesion resection and for performing ERCP after RYGB, while it has the potential for other future applications.
... The transluminal (intragastric) surgery refers to an operation performed inside the peritoneal cavity, which is accessed through a hollow viscosity (stomach) 6 . The intragastric placement of single-port devices has been described by some authors [7][8][9] , with emphasis on the new technique of intragastric sleeve by endoplication, which produces a significant reduction in gastric volume 10 . ...
In order to implement a new bariatric surgery technique, we verify the efficacy of intragastric sleeve to reduce weight gain and subcutaneous adipose tissue (SAT). Animals were divided into two groups: G1 (single-port intragastric sleeve) and G2 (sham group). The stomach was surgically reduced by single-port intragastric sutures to fo a gastric sleeve. Animals were submitted to computer tomography (CT) before the surgical procedure and after 18 weeks. Images were analyzed and measurements of the thickness of SAT, depth and width of the longissimus dorsi muscle and the rib eye area were made. Body weight and CT measurements were analyzed using the GLM PROC. The correlation coefficients were calculated among weight, moments and measures. There was a significant difference in weight gain, in which G1 had an average of 42.803 ± 3.206 kg, lower than G2 (45.966 ± 4.767 kg). The mean values for SAT and muscle measurements differed significantly between groups, in which G1 achieved the lowest values. All variables had significant correlations and high magnitude. Intragastric sleeve surgery induced a significant decrease of SAT. The new intragastric sleeve technique is feasible, safe and effective, mainly in reducing fat deposition, making it an important alternative in bariatric surgical treatment.
... LESS intragastric resection is a novel approach that has mainly been employed in the management of gastric stromal tumours, although its use for gastric bezoar removal has been described [30]. The procedure is particularly useful in cases of Recent Advances in Laparoscopic Surgery endophytic tumours <5 cm, with unfavourable locations, such as the fundus, high lying in the posterior wall of the stomach, or close to the gastroesophageal junction or the pyloric ring [31][32][33]. ...
The evolution of minimally invasive surgery has led to the development of lapa-
roendoscopic single-site (LESS) surgery. The feasibility of almost all types of LESS
upper (GI) procedures has been shown. During the learning phase, substantial
experience in both laparoscopy and upper GI surgery and stringent patient selection
criteria is essential for successful and safe application of the technique, especially
in complex procedures. Comparative studies between LESS and conventional
laparoscopy for various upper GI procedures suggest a non-inferiority of LESS over
standard laparoscopy, although the only objective benefit remains an improved
cosmetic outcome. Intracorporeal instrument collision, lack of triangulation, and
in-line vision are among the main challenges of LESS surgery. The current review
provides a comprehensive report of the specific applications of LESS in upper GI
surgery, with a special reference to advances made to overcome the current tech
ni-
cal difficulties and future perspectives.
... Son et al. [7] and Tudor and Clark [8] have reported an intragastric procedure that involves inserting a wound retractor into the stomach for the retrieval of large trichobezoars in adults and children. The reported advantages of this procedure are safety, shortened operative time, and protection of both the wound edges and the peritoneal cavity. ...
Pancreatic pseudocysts (PPs) often occur in association with acute pancreatitis or pancreatic trauma and are uncommon disorders in children. PPs require operative interventions in case they do not disappear spontaneously. There are several interventional treatments, and laparoscopic or endoscopic treatments have been recently reported as a less invasive procedure. However, these procedures are sometimes difficult to perform for small children. We describe a novel intragastric cystogastrostomy with mini-laparotomy for a 4-year-old female child. She presented with a PP caused by trauma. The PP failed to resolve after 6 weeks and we performed open cystogastrostomy. We made mini-laparotomy and inserted a wound retractor into the stomach and expanded both the abdominal and the gastric walls. This procedure created a good operative field and enabled intragastric cystogastrostomy even in small children. There were no complications. At 10-month postsurgery, a follow-up computed tomography showed no recurrence of PP. This novel intragastric cystogastrostomy for PP, which includes the insertion of a wound retractor, is a safe, minimally invasive, and technically feasible approach for younger children with PP. To the best of our knowledge, this is the first report to describe the intragastric cystogastrostomy with a wound retractor.
... W większości przypadków metodą leczenia z wyboru jest klasyczna metoda operacji z nacięciem żołądka, a czasami także -w przypadku zespołu Roszpunki (Rapunzelsyndrome) -jelita cienkiego, oraz usunięcie zalegających włosów. W piśmiennictwie podaje się próby leczenia endoskopowego oraz laparoskopowego trichobezoaru, a także fragmentacji enzymatycznej [13,14,15,16]. ...
... Stosuje się również endoskopię, laparoskopię, leczenie enzymatyczne, a także metody eksperymentalne, jak np. laserowe rozbijanie zawartości żołądka [13][14][15][16]. ...
... Zaletą tej metody jest mniejszy uraz powłok, wadami -dłuższy czas operacji oraz możliwość skażenia jamy otrzewnej fragmentami bezoaru. W przypadku dużych bezoarów konieczne jest poszerzenie cięcia skórnego w celu usunięcia ich fragmentów z jamy brzusznej [14][15][16]. ...
The iatrogenic chylothorax is caused by a disorder of lymphatic transport within the natural tract. Postoperative iatrogenic chylothorax is the result of damage to the thoracic duct and diagnosis is based on fluid accumulation in the pleura. Lymphoscintigraphy remains the standard in pediatric diagnostics. Imaging tests are used to confirm the presence of fluid in the body cavities. The iatrogenic lymphoma treatment is multi-directional and includes nutritional treatment, pharmacotherapy and surgical treatment. The data were analyzed for patients treated for iatrogenic lymphoma in the Department of Pediatric Surgery of the Warsaw Medical University in the years 2005–2015.
... In the last few years, SI and ML have become novel options for intragastric surgery, as would help to reduce the surgical trauma compared to open and laparoscopic procedures [14]. Different studies of SI intragastric surgery [38,[40][41][42][43][44] and intragastric ML [45][46][47] have been published, but none that compare both techniques in similar conditions. ...
Background:
The aim of this study was to develop an easy-to-induce and reproducible model of gastric submucosal tumor in swine to compare minilaparoscopy (ML) with single-incision (SI) intragastric surgery.
Methods:
Twelve healthy female pigs (weight 30.94 ± 2.49 kg) underwent a transparietal injection of sterile alginate at the level of Z-line (n = 6) and at the pre-pyloric area (n = 6) creating a model of gastric submucosal pseudotumor. The operative procedures included intragastric resection with ML and SI approaches of cardiac and pre-pyloric lesions, with gastroscopic assistance. After resection, the gastric mucosal layer was closed using intracorporeal sutures. The operative time, complication rate and clinical evolution after 1 month were compared in the four groups that the pigs were arranged.
Results:
The pseudotumors ranged in size from 3 to 6 cm in diameter. The access of the gastric cavity and resection of the experimental SMP and suturing of the mucosa were performed successfully in 12 animals using both approaches. Mean time to perform the exeresis of gastric cardia tumors was significantly higher in single-incision approach. No significant differences were observed in the surgical time during pyloric surgery. Minilaparoscopic approach reduced significantly the mucosa closure time in esophagogastric and pyloric pseudotumors. One month after, no alterations were shown in the abdominal cavity using exploratory laparotomy.
Conclusions:
The technical feasibility of performing safe and efficient intragastric approach of submucosal pseudotumors in swine model was verified in this study. Intragastric ML has advantages over SI, namely regarding the reduction in total surgical times and the fewer technical difficulties.
... The modification suggested by Tudor and Clark 9 is a technique in which stomach is sutured to the anterior abdominal wall and a device is used to minimize peritoneal contamination. Son et al, 10 described a method where they used one port to make the gastrostomy and closed it extra corporeally by using staplers. They reported less contamination. ...
Bezoar is an intraluminal mass formed by the accumulation of undigested material anywhere in the gastrointestinal system. Most of small bezoars are removed by gastrointestinal endoscopy, while the best approach for the larger ones is surgical removal. Currently, laparoscopic technique is successfully used in the treatment of bezoars, which are used to be managed by open surgery. In the laparoscopic treatment of bezoars, contamination of peritoneal cavity is a major problem. We describe a modified laparoscopic technique in which an endobag is placed in the stomach instead of the peritoneal cavity in order to avoid spillage of the bezoar during laparoscopic removal. © 2016, Saudi Arabian Armed Forces Hospital. All rights reserved.
... W większości przypadków metodą leczenia z wyboru jest klasyczna metoda operacji z nacięciem żołądka, a czasami także -w przypadku zespołu Roszpunki (Rapunzelsyndrome) -jelita cienkiego, oraz usunięcie zalegających włosów. W piśmiennictwie podaje się próby leczenia endoskopowego oraz laparoskopowego trichobezoaru, a także fragmentacji enzymatycznej [13,14,15,16]. ...
... Stosuje się również endoskopię, laparoskopię, leczenie enzymatyczne, a także metody eksperymentalne, jak np. laserowe rozbijanie zawartości żołądka [13][14][15][16]. ...
... Zaletą tej metody jest mniejszy uraz powłok, wadami -dłuższy czas operacji oraz możliwość skażenia jamy otrzewnej fragmentami bezoaru. W przypadku dużych bezoarów konieczne jest poszerzenie cięcia skórnego w celu usunięcia ich fragmentów z jamy brzusznej [14][15][16]. ...
Objectives
Trichotillomania is a lack of control of one’s hair pulling. It is estimated that about 1% of population develops trichotillomania. In up to 20% of patients with trichotillomania swollowing follows hair pulling. Trichobezoar forms in about 30% of patients with trichofagia.
Methods
In 2008-2014 3 patients were operated on trichobezoar. One patient has had a history of trichotillomania. On admission abdominal X-ray and ultrasonography revealed abdominal mass. Diagnosis was confirmed in abdominal computed tomography.
Results
All three trichobezoars were evacuated from the intestinal tract during laparotomy with wide gastric wall opening. In one case – Rapunzel syndrome – hair mass was evacuated also from the duodenum and small bowel. All patients were referred to psychiatrist after finishing of the surgical treatment.
Conclusions
In patients operated for trichobezoar as well as other patients with trichotillomania control of hair accumulation in the gastrointestinal tract remains a problem. Authors propose endoscopic follow up scheme in 6, 12, and 24 months after the surgery as well as for other patients with trichotillomania.
... In a study of 24 diseases, Yau et al [42] reported that the laparoscopic method had more advantageous outcomes when used in selected patients compared to the open method in terms of operating time, complication rates, and duration of hospital stay. Nirasawa et al [43] reported treatment outcomes with the laparoscopic method in patients with gastric bezoars and Son et al [44] reported such outcomes in patients with gastric bezoars that could not be treated endoscopically. Fraser and Song emphasized that the laparoscopic technique might be used safely in selected patients with giant gastric bezoars [45,46] . ...
... Fraser and Song emphasized that the laparoscopic technique might be used safely in selected patients with giant gastric bezoars [45,46] . Son et al [44] discussed the risk of intra-abdominal contamination and the location of the gastric incision as the points to be considered for ...
The term bezoar refers to an intraluminal mass in the gastrointestinal system caused by the accumulation of indigestible ingested materials, such as vegetables, fruits, and hair. Bezoars are responsible for 0.4%-4% of cases of mechanical intestinal obstruction. The clinical findings of bezoar-induced ileus do not differ from those of mechanical intestinal obstruction due to other causes. The appearance and localization of bezoars can be established with various imaging methods. Treatment of choice depends on the localization of the bezoar which makes the clinical findings.
