Do Paediatric Patients with a Trichobezoar Benefit from a Modified Laparoscopic Approach? A Systematic Review.

Abstract

Trichobezoars represent a rare condition in paediatric patients, and evidence-based treatment recommendations are lacking. Most reported cases describe surgical removal, predominantly by laparotomy.We present a minimally invasive surgical strategy based on two paediatric cases of gastric trichobezoars and review the current literature. A PubMed search was performed including research articles and case reports published between 2016 and 2020. Inclusion criteria were isolated trichobezoars in patients aged ≤18 years, while reports describing combined bezoars were excluded. Extracted data included age, sex distribution, clinical presentation, medical history, imaging, treatment modality, and follow-up management.Thirty-four publications comprising 41 paediatric cases of trichobezoars were identified (age range: 2-17 y; female-to-male ratio: approximately 7:1). Endoscopic removal was attempted in 10 cases, requiring conversion to laparotomy in nine cases and to a modified laparoscopic technique in one case. Overall, 36 bezoars were removed by laparotomy, 5 by a modified laparoscopic technique, and only 1 by purely laparoscopic extraction without auxiliary incision.Our modified minimally invasive approach resulted in an uncomplicated postoperative course and a favourable cosmetic outcome. The technique enables safe removal of trichobezoars while minimising the risk of intra-abdominal contamination.