J Gastric Cancer.  2011 Dec;11(4):230-233.

New Surgical Approach for Gastric Bezoar: "Hybrid Access Surgery" Combined Intragastric and Single Port Surgery

• Son T
• Inaba K
• Woo Y
• Pak KH
• Hyung WJ
• Noh SH

Abstract

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 procedure for the removal of the gastric bezoar using one surgical glove and two wound retractors as a fashion of intragastric single port surgery. Herein we present this new minimal invasive procedure, so named "hybrid access surgery" which involves the use of existing devices and overcomes the weakness of laparoscopic removal of the gastric bezoar. Our new procedure, combining the concept of intragastric and single port access, is acceptable and feasible to retrieve the gastric bezoar. In the future, this procedure may be one of the alternative procedures for retrieving gastric bezoar even when it is incarcerated in the pylorus.

Keyword

Laparoscopy; Bezoars; Intragastric surgery; Single port surgery

MeSH Terms

Bezoars
Gloves, Surgical
Laparoscopy
Peritoneal Cavity
Pylorus

Figure

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  Fig. 1 Preoperative diagnosis of gastric bezoar. (A) Endoscopic finding of gastric bezoar. (B) Heterogeneous mass (arrows) in the pylorus revealed by computed tomography scan.

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  Fig. 2 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.

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