Foreign bodies – classic surgery or minimal invasive approach?

iunie 1, 2016 Articole 0

This brief presentation is about highlighting the advantages of minimal invasive techniques and to bring to attention the limits of these procedures with intestinal tract foreign bodies.

The minimal invasive approach gives both intra and post surgical comfort to our patients even just because there are no more abdominal sutures and the foreign bodies are removed with a rigid or flexible endoscope, using Dormia type baskets, polypectomy baskets, foreign bodies extractors or even biopsy pliers.

In most cases of endoscopic removal of foreign bodies from the stomach, there is no need for hospital care, the patients being as good as new right after waking up from the anesthetic; on the other hand a classic gastrotomy means a long hospital care, specific diets and even possible complications of the gastric wall or the peritoneum, like any other laparatomy.

In the event of a foreign body stuck in the esophagus, endoscopy is a far better approach versus a classical esophagostomy. In this cases, usually the foreign bodies are stuck in the cardiac region and the surgical approach is consistent with thoracotomy, a far more invasive and difficult procedure, both for the surgeon and the patient.

Being successfull with endoscopic removal of foreign bodies is all about a few important factors, but one surgeon should always know that this procedure can turn into a classic surgical approach if some things don’t go as they should during endoscopy.

The key of success is about the expertise of the surgical team, the endoscopy equipment and it’s accessories. There are also patient related factors like the localization of the foreign bodies, the hardness of them, the amount of time from ingestion to the procedure and the lesions that developed.

One endoscopic limit is the passing of the foreign body through the pyloric orifice and then over the first duodenum flexure. In this cases the only solution is a classic laparatomy approach followed by either an enterotomy or an enterectomy, depending on the lesions within the intestinal wall.

IMG_1668 IMG_1669 IMG_1670 IMG_1672 IMG_1678 IMG_1679